Total Ankle Arthroplasty for Rheumatoid Arthritis in Japanese Patients: A Retrospective Study of Intermediate to Long-Term Follow-up

Makoto Hirao; Jun Hashimoto; Hideki Tsuboi; Kosuke Ebina; Akihide Nampei; Takaaki Noguchi; Shigeyoshi Tsuji; Norihiro Nishimoto; Hideki Yoshikawa

doi:10.2106/JBJS.OA.17.00033

Total Ankle Arthroplasty for Rheumatoid Arthritis in Japanese Patients: A Retrospective Study of Intermediate to Long-Term Follow-up

JB JS Open Access. 2017 Nov 28;2(4):e0033. doi: 10.2106/JBJS.OA.17.00033. eCollection 2017 Dec 28.

Authors

Makoto Hirao¹, Jun Hashimoto², Hideki Tsuboi³, Kosuke Ebina¹, Akihide Nampei², Takaaki Noguchi², Shigeyoshi Tsuji², Norihiro Nishimoto^{4

5}, Hideki Yoshikawa¹

Affiliations

¹ Department of Orthopaedics, Osaka University Graduate School of Medicine, Osaka, Japan.
² Department of Orthopaedics/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.
³ Department of Orthopaedics, Osaka Rosai Hospital, Osaka, Japan.
⁴ Osaka Rheumatology Clinic, Osaka, Japan.
⁵ Department of Molecular Regulation for Intractable Diseases Institute of Medical Science, Tokyo Medical University, Tokyo, Japan.

Abstract

Background: Outcomes after total ankle arthroplasty (TAA) combined with additive techniques (augmentation of bone strength, control of soft-tissue balance, adjustment of the loading axis) for the treatment of rheumatoid arthritis were evaluated after intermediate to long-term follow-up. The influences of biologic treatment on the outcomes after TAA were also evaluated.

Methods: We performed a retrospective observational study involving 50 ankles (44 patients) that underwent TAA for the treatment of rheumatoid arthritis. The mean duration of follow-up was 7.1 years. Clinical outcomes were evaluated with use of the Japanese Society for Surgery of the Foot (JSSF) scale score and a postoperative self-administered foot-evaluation questionnaire (SAFE-Q). Radiographic findings were evaluated as well. These parameters also were compared between patients managed with and without biologic treatment.

Results: This procedure significantly improved the clinical scores of the JSSF rheumatoid arthritis foot and ankle scale (p < 0.0001). Forty-eight of the 50 ankles had no revision TAA surgery. Subsidence of the talar component was seen in 8 ankles (6 in the biologic treatment group and 2 in the non-biologic treatment group); 2 of these ankles (both in the biologic treatment group) underwent revision TAA. The social functioning score of the SAFE-Q scale at the time of the latest follow-up was significantly higher in the biologic treatment group (p = 0.0079). The dosage of prednisolone (p = 0.0003), rate of usage of prednisolone (p = 0.0001), and disease-activity score (p < 0.01) at the time of the latest follow-up were all significantly lower in the biologic treatment group.

Conclusions: TAA is recommended for the treatment of rheumatoid arthritis if disease control, augmentation of bone strength, control of soft-tissue balance, and adjustment of the loading axis are taken into account. The prevention of talar component subsidence remains a challenge in patients with the combination of subtalar fusion, rheumatoid arthritis, and higher social activity levels.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.