Low annual revision rate in ankle distraction for ankle osteoarthritis: A systematic review and meta‐analysis

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2024-02, Vol.32 (2), p.344-351
• Main Authors: Hollander, Julian J., Paget, Liam D. A., Dahmen, Jari, Stornebrink, Tobias, Rikken, Quinten G. H., Sierevelt, Inger N., Kerkhoffs, Gino M. M. J., Stufkens, Sjoerd A. S.
• Format: Article
• Language: English
• Subjects: ankle; ankle distraction; ankle joint; Ankle Joint - surgery; Humans; osteoarthritis; Osteoarthritis - surgery; Patient Reported Outcome Measures; Postoperative Complications - epidemiology; Range of Motion, Articular; Reoperation - statistics & numerical data
• ISSN: 0942-2056; 1433-7347; 1433-7347
• DOI: 10.1002/ksa.12049

Purpose Ankle osteoarthritis severely impacts patients' mental and physical quality of life. Besides total ankle replacement and ankle arthrodesis, ankle distraction has been shown to be a promising alternative. The primary aim of the present study was to determine the annual revision rates (ARRs) after ankle distraction. The secondary aim was to obtain an overview of patient‐reported outcome measures and functional outcomes. Methods A literature search until November 2023 was performed. Methodological quality was assessed using the methodological index for non‐randomised studies criteria. Primary outcome was the ARR which was log‐transformed and pooled using a random effects model. Secondary outcomes were pooled using a simplified pooling technique and included the American Orthopaedic Foot & Ankle Society Ankle‐Hindfoot Scale (AOFAS), range of motion (ROM) and post‐operative complications. Results The literature search resulted in 287 articles, of which 10 studies, comprising 602 patients, were included. The patients had a pooled mean age of 47 years (range of means: 40–68) and a mean follow‐up of 35 months (range of means: 24–48). The overall methodological quality was moderate to fair. The pooled ARR after ankle distraction was 4% (95% confidence interval [CI], 3%–7%). Pooling of AOFAS showed mean 26‐point improvement (from 54 to 80). Additionally, ROM dorsiflexion improved at 5°, and the plantarflexion remained at 31°. The overall complication rate was 41% (95% CI, 35%–48%), of which 77% (95% CI, 67%–85%) were pin‐tract infections. Conclusion Ankle distraction results in an ARR of 4% (95% CI, 3%–7%) with clinically relevant improved AOFAS scores. The overall complication rate is 41% and is mainly attributable to treatable pin‐tract infections (77% of recorded complications). Level of Evidence Level IV, Systematic Review and Meta‐Analysis.