Background/Purpose:  In progress of medical treatment against rheumatoid arthritis (RA) disease activity using methotrexate (MTX) and/or biologics, we often see cases that require surgical intervention for progressive ankle joint destruction and disorder. Total ankle arthroplasty (TAA) had been one of the procedures for destructive ankle joint in RA cases. In this situation, whether biologics treatment could contribute to improve the outcomes after TAA is not elucidated.

Methods:  A retrospective observational study was completed for 21 cases receiving a mobile-bearing ankle prosthesis design for treatment of rheumatoid ankle from October 2010 to May 2014. Duration of the postoperative observation was between 2 and 6 years. The FINE mobile-bearing prosthesis (Teijin-Nakashima Medical Co., Ltd., Okayama, Japan) was used. Within 21 cases, 10 cases were treated with biologics (infliximab, etanercept, tocilizumab, abatacept), and 11 cases were treated with NON-biologics drugs (MTX, tacrolimus, salazosulfapyridine, bucilamine). Preoperative and postoperative score for Japanese Society of surgery of Foot (JSSF) RA foot ankle scale was evaluated. A postoperative self-administered foot evaluation questionnaire (SAFE-Q) was also administered at the final follow-up. Prosthesis sinking, appearance of radiolucent area, tilting angle between tibial and talar compornent were investigated as radiographic evaluation. These parameters were compared between bio group and NON-bio group.

Results:  There was no significant difference between the two groups in disease duration (bio: 20.1±11.2 years, NON-bio: 18.2±7.7 years), age (bio: 62.9±3.0 years old, NON-bio: 67.2±1.5 years old), DAS28-CRP score (bio: 2.53±0.48, NON-bio: 2.86±0.83), and doze of administered prednisolone (bio: 1.2±2.1 mg/day, NON-bio: 2.2±2.2 mg/day). On the other hand, the proportion of cases without prednisolone administration was significantly high in bio group (bio :7/10 [70%], NON-bio: 3/11 [27%]). In both groups, JSSF score was significantly improved after surgery, and there was no significant difference in postoperative score between the two groups. In SAFE-Q score at the final follow-up, there was no significant difference between the two groups, pain and pain related index (bio: 77.9±15.3, NON-bio: 82.4±10.9), physical functioning and daily living index (bio: 53.2±25.7, NON-bio: 52.7±17.3), social functioning (bio: 57.5±35.0, NON-bio: 45.4±32.7), shoe related index (bio: 46.7±48.2, NON-bio: 59.2±29.8), general health and well-being index (bio: 60.0±34.1, NON-bio: 76.8±22.6). In radiographic findings, appearance of radiolucent area in posterior tibial component was seen in 4 cases of biologics group. Talar prosthesis sinking was seen in 3 cases of biologics group. Tilting angle between components showed no significant difference between the two groups (bio: 0.3±0.2 degrees, NON-bio: 0.2±0.25 degrees).

Conclusion: No significant difference in postoperative clinical outcomes after TAA was found between biologics treatment group and NON-biologics treatment group within 2-6 years follow-up. Control of the disease activity is firstly important, and when tight control of RA was achieved even in NON-biologics treatment cases, TAA seems to be appropriate for RA patients. However, because biologics has the ability to stop the administration of prednisolone, biologics treatment cases has theoretically an advantage for prosthesis durability from the perspective of the strength of bone mineral structure. Long term follow-up is required.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-clinical-outcomes-of-total-ankle-arthroplasty-between-biologics-and-non-biologics-treatment-groups-in-patients-with-rheumatoid-arthritis/