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Scientific Articles   |    
Total Ankle Replacement in Patients with Gouty Arthritis
Alexej Barg, MD1; Markus Knupp, MD1; Ashley L. Kapron, BS2; Beat Hintermann, MD1
1 Clinic of Orthopaedic Surgery, Kantonsspital Liestal, Rheinstrasse 26, CH-4410 Liestal, Switzerland. E-mail address for A. Barg: alexejbarg@mail.ru
2 Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the Basel Foundation Orthopaedic Surgery and Biomechanics of Foot and Ankle. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Integra).

Investigation performed at the Clinic of Orthopaedic Surgery, Kantonsspital Liestal, Liestal, Switzerland

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Feb 16;93(4):357-366. doi: 10.2106/JBJS.J.00957
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Abstract

Background: 

Gout is the most common cause of inflammatory arthritis in men and older women. The purpose of this review was to assess prosthetic component stability, postoperative pain relief, functional outcome, and quality of life of patients with gouty ankle arthritis who were treated with total ankle replacement.

Methods: 

Sixteen patients (nineteen ankles) with chronic gout and a mean age (and standard deviation) of 65.2 ± 5.5 years were treated with a non-constrained three-component total ankle arthroplasty because of painful ankle arthritis. The average duration of follow-up was 5.1 ± 2.5 years. Component stability was assessed with use of weight-bearing radiographs. Clinical outcomes were analyzed with use of a visual analogue scale (VAS) for pain, a 36-item short-form health survey (SF-36), and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score.

Results: 

There were no intraoperative complications. In one patient, both arthroplasties were revised 4.7 years postoperatively because of painful prosthetic loosening. The average VAS score for pain decreased significantly from 7.5 ± 1.8 (range, 5 to 10) to 1.2 ± 1.3 (range, 0 to 3) (p < 0.001). All eight categories of the SF-36 score showed significant improvement (all p < 0.001). The average AOFAS hindfoot score increased significantly from 38 ± 15 (range, 15 to 77) preoperatively to 75 ± 13 (range, 54 to 92) postoperatively (p < 0.001).

Conclusions: 

Total ankle replacement in patients with painful gouty ankle arthritis is associated with a low risk of intraoperative and postoperative complications and leads to significant pain relief, high patient satisfaction, and good functional results.

Level of Evidence: 

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

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    Accreditation Statement
    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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