BACKGROUND: At present, artificial ankle arthroplasty and arthroscopic ankle fusion can be used in the treatment of severe traumatic arthritis, but which kind of treatment can make patients more benefit is not conclusive.
OBJECTIVE: To explore the clinical efficacy and safety of artificial ankle arthroplasty and ankle joint fusion in the treatment of traumatic ankle arthritis.
METHODS: A retrospective study was conducted in 64 ankles of 64 patients with traumatic ankle arthritis who were treated by conservative treatment in Nanjing Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine from January 2012 to December 2015. They were divided into observation group and control group according to the surgical procedure accepted by the patients. In the observation group, 26 patients (26 ankles) underwent artificial ankle arthroplasty. In the control group, 38 patients (38 ankles) received ankle arthrodesis. The operation status, hospitalization time, postoperative complications, revision rate, limp rate and post-discharge follow-up were recorded and compared between the two groups. The preoperative and postoperative ankle Kofoed score, Visual Analogue Scale (VAS) score and the American Orthopedic Foot and Ankle Society Score (AOFAS) score were evaluated and compared between the two groups.
RESULTS AND CONCLUSION:
(1) The operation time of the control group was significantly higher than that of the observation group (P
< 0.05). The intraoperative blood loss, operation cost and postoperative hospital stay were significantly higher in the observation group than in the control group (P
< 0.05). (2) The scores of Kofoed, VAS and AOFAS were significantly higher at 6 months and 1 year after operation than those before operation in the two groups (P
< 0.05). There was no significant difference in the scores of Kofoed, VAS and AOFAS between the two groups (P
> 0.05). The Kofoed score and the AOFAS score were significantly better in the observation group than in the control group at 6 months and 1 year after operation (P
< 0.05). There was no significant difference in VAS score between the two groups at 6 months and 1 year after operation (P
> 0.05). (3) The postoperative infection rate, incision healing rate, fibrous adhesions and ankle pain or swelling rate were significantly lower in the control group than those in the observation group (P
< 0.05). (4)The revision rate of the control group was significantly lower than that of the observation group at 1 year, but the degree of mild claudication was significantly higher than that of the observation group (P
< 0.05). (5) In conclusion, arthroscopic ankle joint fusion has the advantages of small trauma, low cost and short postoperative hospital stay, but it has higher limp rate after operation. Artificial ankle joint fusion has the advantages of improving ankle joint function and activity. However, its postoperative revision rate and the incidence of partial complications are relatively high. Therefore, in the practical application, we should take full account of the patient's condition, age and economic conditions, choose the optimal treatment program, and actively avoid all kinds of postoperative complications, and improve the quality of life after surgery.