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Motion Versus Fixed Distraction of the Joint in the Treatment of Ankle OsteoarthritisA Prospective Randomized Controlled Trial
Charles L. Saltzman, MD1; Stephen L. Hillis, PhD2; Mary P. Stolley, RN, MS3; Donald D. Anderson, PhD4; Annunziato Amendola, MD3
1 Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address: Charles.saltzman@hsc.utah.edu
2 Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Medical Center (152), 601 Highway 6 West, Iowa City, IA 52246. E-mail address: steve-hillis@uiowa.edu
3 Department of Orthopaedics & Rehabilitation, University of Iowa Healthcare, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for M.P. Stolley: patty-stolley@uiowa.edu. E-mail address for A. Amendola: ned-amendola@uiowa.edu
4 Department of Orthopaedics & Rehabilitation and Department of Biomedical Engineering, Orthopaedic Biomechanics Laboratory, University of Iowa, 2181 Westlawn, Iowa City, IA 52242. E-mail address: don-anderson@uiowa.edu
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the University of Iowa Hospital and Clinics, Iowa City, Iowa

A commentary by Thomas G. Harris, MD, is linked to the online version of this article at jbjs.org.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jun 06;94(11):961-970. doi: 10.2106/JBJS.K.00018
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Initial reports have shown the efficacy of fixed distraction for the treatment of ankle osteoarthritis. We hypothesized that allowing ankle motion during distraction would result in significant improvements in outcomes compared with distraction without ankle motion.


We conducted a prospective randomized controlled trial comparing the outcomes for patients with advanced ankle osteoarthritis who were managed with anterior osteophyte removal and either (1) fixed ankle distraction or (2) ankle distraction permitting joint motion. Thirty-six patients were randomized to treatment with either fixed distraction or distraction with motion. The patients were followed for twenty-four months after frame removal. The Ankle Osteoarthritis Scale (AOS) was the main outcome variable.


Two years after frame removal, subjects in both groups showed significant improvement compared with the status before treatment (p < 0.02 for both groups). The motion-distraction group had significantly better AOS scores than the fixed-distraction group at twenty-six, fifty-two, and 104 weeks after frame removal (p < 0.01 at each time point). At 104 weeks, the motion-distraction group had an overall mean improvement of 56.6% in the AOS score, whereas the fixed-distraction group had a mean improvement of 22.9% (p < 0.01).


Distraction improved the patient-reported outcomes of treatment of ankle osteoarthritis. Adding ankle motion to distraction showed an early and sustained beneficial effect on outcome.

Level of Evidence: 

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

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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