Ho-Seong Lee1, Ji-Yong Ahn1, Jong-Seok Lee1, Jun-Young Lee2, Jae-Jung Jeong3, Young Rak Choi4. 1. Department of Orthopaedic Surgery, Foot and Ankle Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, South Korea. E-mail address for H.-S. Lee: hosng@amc.seoul.kr. 2. Department of Orthopaedic Surgery, Foot and Ankle Surgery, Chosun University School of Medicine, Gwangju, South Korea. 3. Department of Orthopaedic Surgery, Foot and Ankle Surgery, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daeheung-dong, jung-gu, Daejeon, South Korea. 4. Department of Orthopaedic Surgery, Foot and Ankle Surgery, CHA Bundang Medical Center, CHA University, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea.
Abstract
BACKGROUND: The aim of this study was to investigate the outcomes of cement arthroplasty used as a primary salvage procedure to treat ankle joint destruction. METHODS: This study included sixteen patients who underwent primary cement arthroplasty from May 2004 to March 2012 because of an ankle disorder, including intractable infection, nonunion, or a large bone defect or tumor. The mean age of the patients was fifty-seven years (range, twenty-three to seventy-four years), and the mean follow-up period was thirty-nine months (range, fourteen to 100 months). The cement spacer position, cement breakage, osteolysis around the inserted cement, and alignment of the joint were evaluated radiographically. American Orthopaedic Foot & Ankle Society (AOFAS) scores and visual analogue scale (VAS) pain scores were recorded preoperatively and at the time of final follow-up. Functional questionnaires were used to assess the duration for which the patient could walk continuously, use of walking aids, sports activity, consumption of pain medication, and the patient's subjective assessment of the percentage of overall improvement compared with before the cement arthroplasty. RESULTS: The cement spacer was retained without breakage for a mean of thirty-nine months (range, fourteen to 100 months). Osteolysis around the cement was observed in one patient at seventy-eight months, and subluxation developed in one patient. The mean AOFAS and VAS pain scores improved from 39 (range, 11 to 71) preoperatively to 70 (range, 47 to 88) postoperatively (p = 0.001) and from 8 (range, 4 to 9) to 3 (range, 1 to 7) (p = 0.001), respectively. At the final follow-up evaluation, nine of the sixteen patients did not require walking aids, ten used no pain medication, and nine were able to walk continuously for more than an hour. One patient complained of persistent pain and was considered to have had a failure of the procedure. CONCLUSIONS: Primary cement arthroplasty might be a treatment option for advanced ankle destruction in elderly and less active patients. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
BACKGROUND: The aim of this study was to investigate the outcomes of cement arthroplasty used as a primary salvage procedure to treat ankle joint destruction. METHODS: This study included sixteen patients who underwent primary cement arthroplasty from May 2004 to March 2012 because of an ankle disorder, including intractable infection, nonunion, or a large bone defect or tumor. The mean age of the patients was fifty-seven years (range, twenty-three to seventy-four years), and the mean follow-up period was thirty-nine months (range, fourteen to 100 months). The cement spacer position, cement breakage, osteolysis around the inserted cement, and alignment of the joint were evaluated radiographically. American Orthopaedic Foot & Ankle Society (AOFAS) scores and visual analogue scale (VAS) pain scores were recorded preoperatively and at the time of final follow-up. Functional questionnaires were used to assess the duration for which the patient could walk continuously, use of walking aids, sports activity, consumption of pain medication, and the patient's subjective assessment of the percentage of overall improvement compared with before the cement arthroplasty. RESULTS: The cement spacer was retained without breakage for a mean of thirty-nine months (range, fourteen to 100 months). Osteolysis around the cement was observed in one patient at seventy-eight months, and subluxation developed in one patient. The mean AOFAS and VAS pain scores improved from 39 (range, 11 to 71) preoperatively to 70 (range, 47 to 88) postoperatively (p = 0.001) and from 8 (range, 4 to 9) to 3 (range, 1 to 7) (p = 0.001), respectively. At the final follow-up evaluation, nine of the sixteen patients did not require walking aids, ten used no pain medication, and nine were able to walk continuously for more than an hour. One patient complained of persistent pain and was considered to have had a failure of the procedure. CONCLUSIONS:Primary cement arthroplasty might be a treatment option for advanced ankle destruction in elderly and less active patients. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.