Treatment Options for Osteoarthritis of the Ankle: Appropriate Distinction Between Brace Treatment and Arthrodesis

CATEGORY: Ankle Arthritis INTRODUCTION/PURPOSE: Ankle arthrodesis (fusion) for the treatment of osteoarthritis of the ankle (OA) was reported to have good therapeutic results; however, this has not been compared with conservative treatment. At this conference last year, brace treatment using an ankle-foot orthosis, Hiflex Foot Gear (HFG), was also reported to have good therapeutic results, which allows for slight mobility in the ankle joint while providing appropriate level of support for the ankle joint. On this occasion, the therapeutic results of brace treatment and fusion were compared, and treatment options for OA were examined. METHODS: Subjects included nine cases and ten feet in a group that was diagnosed with stage IIIb OA or worse according to the Takakura Classification and were treated with HFG (mean age of 70.6 years, mean course observation period of 8.4 months) and nine cases and ten feet in a group that was treated with fusion for the same diagnosis (mean age of 58.1 years, mean course observation period of 25.5 months). The pre-treatment and post-treatment physician-initiated objective evaluation by the Japanese Society for Surgery of the Foot scale (JSSF scale) and patient-reported subjective evaluation by the Japanese Orthopaedic Association/ the Japanese Society for Surgery of the Foot, and subscales of Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were examined, and improvements in each score in two groups were compared (post-treatment vs pre-treatment) by an unpaired t-test. The validity and reliability of JSSF scale and SAFE-Q have been established by psychometric verification RESULTS: The improvement after the treatment for the HFG group and the fusion group was observed. JSSF scores were 16.1 (p < 0.001) and 35.5 (p < 0.001), respectively, and pain and pain-related scores in the SAFE-Q were 20.8 (p = 0.021) and 35.4 (p < 0.001), respectively. Physical function and daily living were 12.8 (p < 0.001) and 18.6 (p = 0.007), respectively, while social functioning scores were 18.0 (p = 0.001) and 32.8 (p = 0.001), respectively. The JSSF score for both groups was significantly improved. In SAFE-Q, physical function and daily living improved significantly in the HFG group, while pain and pain-related improved significantly in the fusion group.