Distinctive Pain Course during First Year after Total Ankle Arthroplasty: A Prospective,Observational Study

Abstract

Background: Patients and health care professionals alike are often surprised by the course of pain after total ankle arthroplasty (TAA). The current study aimed to determine the baseline patterns of postoperative symptoms during the first year following uncomplicated TAA. Materials and Methods: In a prospective observational study 28 patients with unilateral posttraumatic osteoarthritis were tested for pain with a visual analogue scale, swelling (min grade, 0; max grade, 4), ankle range of motion, and AOFAS ankle score. Assessments were performed preoperatively and 6 weeks, 3, 6, 9, and 12 months after TAA. Results: At 6 weeks all variables had improved significantly. However, at 3 months a relapse with deterioration of mean variables was found. These improved asymptotically during assessments at 6, 9, and 12 months. Conclusion: Our data suggest patients undergoing uncomplicated TAA have to overpass what we believe is an adaptive inflammatory phase with increased periarticular pain and swelling about 3 months after surgery. This distinctive course may influence patient education and increase confidence of healthcare professionals involved in the rehabilitation of TAA patients.

Level of Evidence: II, Prospective Observational Study

Keywords

Total Ankle Arthroplasty Rehabilitation First Year Pain Course Relapse Recurrence of Pain

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References

Bondy

Sims

Schroeder

Offord

Narr

: The effect of anesthetic patient education on preoperative patient anxiety. Reg Anesth Pain Med, 24: 158–164, 1999.

Bozic

Kinder

Meneghini

et al.: Implant survivorship and complication rates after total knee arthroplasty with a third-generation cemented system: 5 to 8 years followup. Clin Orthop Relat Res, 117–124, 2005. https://dx-doi-org.web.bisu.edu.cn/10.1097/01.blo.0000146539.23869.14.

Bragdon

Burke

Lowenstein

et al.: Differences in stiffness of the interface between a cementless porous implant and cancel-lous bone in vivo in dogs due to varying amounts of implant motion. J Arthroplasty, 11: 945–951, 1996. https://dx-doi-org.web.bisu.edu.cn/10.1016/S0883-5403(96)80136-7.

Bragdon

Jasty

Greene

Rubash

Harris

: Biologic fixation of total hip implants. Insights gained from a series of canine studies. J Bone Joint Surg Am, 86-A Suppl 2: 105–117, 2004.

Button

Pinney

: A meta-analysis of outcome rating scales in foot and ankle surgery: Is there a valid, reliable, and responsive system? Foot Ankle Int, 25: 521–525, 2004.

Dripps

Lamont

Eckenhoff

: The role of anesthesia in surgical mortality. JAMA, 178: 261–266, 1961.

Easley

Vertullo

Urban

Nunley

: Total ankle arthroplasty. J Am Acad Orthop Surg, 10: 157–167, 2002.

Egbert

Battit

Welch

Bartlett

: Reduction of postoperative pain by encouragement and instruction of patients. A study of doctor-patient rapport. N Engl J Med, 270: 825–827, 1964. https://dx-doi-org.web.bisu.edu.cn/10.1056/NEJM196404162701606.

Le Quintrec

Giraudet JS

Coste

Vastel

et al.: Positive effect of patient education for hip surgery: A randomized trial. Clin Orthop Relat Res, 112–120, 2003. https://dx-doi-org.web.bisu.edu.cn/10.1097/01.blo.0000079268.91782.bc.

10.

Gould

Alvine

Mann

Sanders

Walling

: Total ankle replacement: A surgical discussion. Part II. The clinical and surgical experience. Am J Orthop, 29: 675–682, 2000.

11.

Haddad

Coetzee

Estok

et al.: Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature. J Bone Joint Surg Am, 89: 1899–1905, 2007. https://dx-doi-org.web.bisu.edu.cn/10.2106/JBJS.F.01149.

12.

Hintermann

Valderrabano

Dereymaeker

Dick

: The HINTEGRA ankle: Rationale and short-term results of 122 consecutive ankles. Clin Orthop Relat Res, 57–68, 2004. https://dx-doi-org.web.bisu.edu.cn/10.1097/01.blo.0000132462.72843.e8.

13.

Klafta

Roizen

: Current understanding of patients' attitudes toward and preparation for anesthesia: A review. Anesth Analg, 83: 1314–1321, 1996. https://dx-doi-org.web.bisu.edu.cn/10.1097/00000539-199612000-00031.

14.

Lin

Moseley

Refshauge

: Rehabilitation for ankle fractures in adults. Cochrane Database Syst Rev, CD005595, 2008.

15.

Mackey

: Mechanisms of inflammatory pain: Therapeutic implications. J Clin Rheumatol, 10: S5–S11, 2004. https://dx-doi-org.web.bisu.edu.cn/10.1097/01.rhu.0000130684.35729.55.

16.

Morrey

Wiedeman

Jr. : Complications and long-term results of ankle arthrodeses following trauma. J Bone Joint Surg Am, 62: 777–784, 1980.

17.

Pagenstert

Hintermann

Barg

Leumann

Valderrabano

: Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res, 462: 156–168, 2007. https://dx-doi-org.web.bisu.edu.cn/10.1097/BLO.0b013e318124a462.

18.

Price

McGrath

Rafii

Buckingham

: The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain, 17: 45–56, 1983.

19.

Ranawat

: Pain management and accelerated rehabilitation for total hip and total knee arthroplasty. J Arthroplasty, 22: 12–15, 2007. https://dx-doi-org.web.bisu.edu.cn/10.1016/j.arth.2007.05.040.

20.

Reading

: The short term effects of psychological preparation for surgery. Soc Sci Med [Med Psychol Med Sociol, 13A: 641–654, 1979.

21.

Spirt

Assal

Hansen

Jr. : Complications and failure after total ankle arthroplasty. J Bone Joint Surg Am, 86-A: 1172–1178, 2004.

22.

Valderrabano

Nigg

Von Tscharner

Frank

Mann

Hinter B

: J. Leonard Goldner Award 2006. Total ankle replacement in ankle osteoarthritis: an analysis of muscle rehabilitation. Foot Ankle Int, 28: 281–291, 2007. https://dx-doi-org.web.bisu.edu.cn/10.3113/FAI.2007.0281.

23.

Valderrabano

Nigg

Von Tscharner

et al.: Gait analysis in ankle osteoarthritis and total ankle replacement. Clin Biomech (Bristol, Avon), 22: 894–904, 2007. https://dx-doi-org.web.bisu.edu.cn/10.1016/j.clinbiomech.2007.05.003.

24.

Valderrabano

Pagenstert

Horisberger

Knupp

Hintermann

: Sports and recreation activity of ankle arthritis patients before and after total ankle replacement. Am J Sports Med, 34: 993–999, 2006. https://dx-doi-org.web.bisu.edu.cn/10.1177/0363546505284189.

25.

Wood

Deakin

: Total ankle replacement. The results in 200 ankles. J Bone Joint Surg Br, 85: 334–341, 2003. https://dx-doi-org.web.bisu.edu.cn/10.1302/0301-620X.85B3.13849.

26.

Zeni

Jr. Mackler

Snyder L

: Clinical Outcomes After Simultaneous Bilateral Total Knee Arthroplasty Comparison to Unilateral Total Knee Arthroplasty and Healthy Controls. J Arthroplasty, 2009. e-pub ahead of print, PM:19356894.

27.

Zoch

Moser

Fialka V

Quittan

: Rehabilitation of ligamentous ankle injuries: A review of recent studies. Br J Sports Med, 37: 291–295, 2003. https://dx-doi-org.web.bisu.edu.cn/10.1136/bjsm.37.4.291.