Article

Can Ilizarov joint distraction delay the need for an arthrodesis of the ankle? A preliminary report.

Department of Rheumatology, University Hospital Utrecht, The Netherlands.
Journal of Bone and Joint Surgery - British Volume (impact factor: 2.83). 10/1995; 77(5):720-5. pp.720-5
Source: PubMed

ABSTRACT We applied joint distraction using an Ilizarov apparatus in 11 patients with post-traumatic osteoarthritis of the ankle to try to delay the need for an arthrodesis. Distraction for three months resulted in clinical improvement in pain and mobility for a mean of two years, with an increase in the joint space. We considered that these effects may be produced by the absence of mechanical stress on the cartilage combined with the intra-articular hydrostatic pressures during distraction. We measured these pressures during walking with distraction, and found levels very similar to those reported to improve osteoarthritic cartilage when applied in vitro.

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    Nazzar Tellisi, Austin T Fragomen, Dawn Kleinman, Martin J O'Malley, S Robert Rozbruch
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    ABSTRACT: In recent years ankle distraction arthroplasty has gained popularity in the treatment of ankle arthritis as a means of both maintaining range of motion and avoiding fusion. We present a retrospective review of 25 patients who have undergone ankle distraction from 1999 to 2006. The mean age was 43 years; 16 were male, and 7 were female. Followup was 30 months after frame removal (range, 12 to 60 months). We were able to obtain followup on 23 of 25 patients. Adjuvant procedures were performed in some cases including Achilles tendon lengthening (5), ankle arthroscopy (4), open arthrotomy (1), and supramalleolar tibial and distal fibular osteotomy to correct distal tibial deformity (6). Twenty-one patients (91%) reported improved pain with those furthest post-op experiencing the best results. The average preoperative AOFAS score was 55 (range, 29 to 82), and the average postoperative score was 74 (range, 47 to 96). The difference between pre- and postoperative scores was significant (p = 0.005). SF-36 scores showed modest improvement in all components. Only two of the patients in the study underwent fusion after ankle distraction. Total ankle motion was maintained in all patients with improvement in the functional arc of motion in five patients who started with mild equinus contractures. We feel that ankle distraction offers a promising solution for many people with ankle arthritis.
    The Foot and Ankle Online Journal 05/2009; 30(4):318-25. · 1.22 Impact Factor
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    ABSTRACT: With the advances in trauma care, chronic fracture dislocation of the ankle is not a condition commonly seen in modern clinical practice. When encountered, it can be difficult to preserve the ankle joint. We present a case of a 65-year-old female, with a chronic fracture dislocation of the ankle. The ankle joint was subluxated with posterior translation of the talus, displacement of the posterior malleolus fragment, and a distal fibula fracture. A minimally traumatic approach was devised to treat this complex fracture dislocation which included gradual reduction of the ankle with a Taylor spatial frame, followed by stabilization with internal fixation and removal of the frame. Bony union and restoration of the ankle joint congruency was achieved.
    HSS Journal 02/2011; 7(1):85-8.
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    Article: Tissue structure modification in knee osteoarthritis by use of joint distraction: an open 1-year pilot study.
    Femke Intema, Peter M Van Roermund, Anne C A Marijnissen, Sebastian Cotofana, Felix Eckstein, Rene M Castelein, Johannes W J Bijlsma, Simon C Mastbergen, Floris P J G Lafeber
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    ABSTRACT: Modification of joint tissue damage is challenging in late-stage osteoarthritis (OA). Few options are available for treating end-stage knee OA other than joint replacement. To examine whether joint distraction can effectively modify knee joint tissue damage and has the potential to delay prosthesis surgery. 20 patients (<60 years) with tibiofemoral OA were treated surgically using joint distraction. Distraction (~5 mm) was applied for 2 months using an external fixation frame. Tissue structure modification at 1 year of follow-up was evaluated radiographically (joint space width (JSW)), by MRI (segmentation of cartilage morphology) and by biochemical markers of collagen type II turnover, with operators blinded to time points. Clinical improvement was evaluated by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analogue Scale (VAS) pain score. Radiography demonstrated an increase in mean and minimum JSW (2.7 to 3.6 mm and 1.0 to 1.9 mm; p<0.05 and <0.01). MRI revealed an increase in cartilage thickness (2.4 to 3.0 mm; p<0.001) and a decrease of denuded bone areas (22% to 5%; p<0.001). Collagen type II levels showed a trend towards increased synthesis (+103%; p<0.06) and decreased breakdown (-11%; p<0.08). The WOMAC index increased from 45 to 77 points, and VAS pain decreased from 73 to 31 mm (both p<0.001). Joint distraction can induce tissue structure modification in knee OA and could result in clinical benefit. No current treatment is able to induce such changes. Larger, longer and randomised studies on joint distraction are warranted.
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Keywords

cartilage
 
Ilizarov apparatus
 
intra-articular hydrostatic pressures
 
joint distraction
 
joint space
 
mechanical stress
 
osteoarthritic cartilage
 
post-traumatic osteoarthritis
 
pressures
 

A A van Valburg