Ankle Distraction for End-Stage OA

Treatment may prolong natural joint function

Scientific Poster P209—on display in Academy Hall—reports that ankle distraction is an effective surgical treatment for end-stage ankle osteoarthritis (OA).

The researchers retrospectively reviewed data on 109 patients with longer than 1-year follow-up who had been treated with ankle distraction or ankle distraction with simultaneous supramalleolar osteotomy (SMO) for deformity correction. The purpose of the study was to determine the effectiveness of ankle distraction for joint preservation; the primary outcome was the need for fusion, replacement, or repeat distraction. The researchers also sought to determine factors contributing to ankle distraction survival including patient demographics, medical comorbidities, and adjunct surgical procedures.

Patients were queried by phone to determine the status of the ankle (natural vs. failed). The researchers reviewed the patients’ chart data to determine patient demographics, medical comorbidities, and surgical procedures.

Overall, 10 patients (9 percent) required fusion, replacement, or repeat distraction. Statistical analysis revealed that patients with neutral alignment and those with supramalleolar deformity that required realignment at the time of distraction demonstrated an average survival of 11.4 years and 8.8 years, respectively (P = .02). Among the 10 patients in whom distraction failed, seven required both repeat ankle distraction and an SMO. No significant differences in survival were found among patients treated with or without gastrocnemius recession, bone marrow aspirate injection, microfracture, or arthrotomy vs. arthroscopy. The researchers also found no significant differences in survival between age, laterality, or gender. In addition, comorbidities, including smoking, diabetes, rheumatoid arthritis, and gout were not significantly different between groups. Post-traumatic osteonecrosis of the talus, however, was associated with a significant risk of failure (P = .11).

Based on the study’s results, the researchers conclude that ankle distraction is an effective operation for the treatment of end-stage ankle OA. “While less effective, this is a clinically significant time to be able to postpone a fusion and, in some cases, make replacement an option by restoring alignment,” the authors write. “Our ability to identify adjunct surgical procedures that may increase survival and risk factors that may predispose to failure is limited by the low number of patients requiring additional procedures.”          

Authors of P209 “Ankle distraction for end-stage ankle arthritis: a survival analysis” are Stephen Greenfield, MD; Austin Thomas Fragomen, MD; and S. Robert Rozbruch, MD.

Details of the authors’ disclosure as submitted to the Orthopaedic Disclosure Program can be found in the Final Program; the most current disclosure information may be accessed electronically at