Total Ankle Arthroplasty for Rheumatoid Arthritis Cases in This Biologics Era: Mid to Long-Term Follow-up

Makoto Hirao¹, Jun Hashimoto², Hideki Tsuboi³, Kosuke Ebina⁴ and Hideki Yoshikawa⁵, ¹Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan, ²Rheumatology/Orthopaedics, Osaka-Minami Medical Ctr, Kawachinagano, Japan, ³Orthopaedics/Rheumatology, Osaka Rosai Hospital, Sakai, Japan, ⁴Orthopaedics, Osaka University Graduate School of Medicine, Suita, Japan, ⁵Department of Orthopedics, Osaka University Graduate School of Medicine, Suita Osaka, Japan

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Biologics, outcomes, rheumatoid arthritis (RA) and total joint replacement

Session Information

Date: Sunday, November 5, 2017

Title: Orthopedics, Low Back Pain and Rehabilitation Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Outcomes after total ankle arthroplasty (TAA) combined with additive techniques (augmentation of bone strength, control of soft tissue balance, adjustment of the loading axis) for destructive rheumatoid arthritis (RA) cases were evaluated after mid to long-term follow-up. The influences of biologic treatment on the outcomes after TAA were also evaluated.

Methods: A retrospective observational study was completed involving 50 RA cases [mean follow-up period: 7.1 years] who underwent TAA. RA foot ankle scales were administered using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a postoperative self-administered foot evaluation questionnaire (SAFE-Q) was also checked at final follow-up. Radiographic findings were also checked.

Results: This procedure significantly improved the clinical scores of the JSSF RA foot and ankle scales. Of 50 ankles, 48 had no revision TAA surgery. Prosthesis sinking at the talus side was seen in 8 ankles (6 ankles in biologics group, 2 ankles in non-biologics group); 2 required revision TAA. The social functioning score of the SAFE-Q scale at final follow-up was significantly higher in the biologic treatment group than in the non-biologic group. The biologic treatment group showed a significantly lower rate of prednisolone usage (12%) than the non-biologic treatment group (71%), and disease activity was significantly improved in the biologic treatment group at final follow-up.

Conclusion: TAA is recommended for RA cases, if disease control, augmentation of bone strength, control of soft tissue balance, and adjustment of loading axis are taken into account. Withdrawal of the steroid in biologics treatment might have a good effect on the durability of prostheses in long-term observation in the perspective of bone-mineral structure. Biologics treatment contributed to increase social activity after TAA in RA cases. So, prevention of talar component sinking for RA cases with such higher social activity should be further discussed and resolved in this biologics era.

Disclosure: M. Hirao, None; J. Hashimoto, None; H. Tsuboi, None; K. Ebina, Chugai Pharmaceutical, Eisai, Ono Pharmaceutical, Mitsubishi Tanabe Pharma, UCB Japan, 8; H. Yoshikawa, Chugai Pharmaceutical, Eisai, Ono Pharmaceutical, Mitsubishi Tanabe Pharma, Phizer, Astellas Pharma, 2.

To cite this abstract in AMA style:

Hirao M, Hashimoto J, Tsuboi H, Ebina K, Yoshikawa H. Total Ankle Arthroplasty for Rheumatoid Arthritis Cases in This Biologics Era: Mid to Long-Term Follow-up [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/total-ankle-arthroplasty-for-rheumatoid-arthritis-cases-in-this-biologics-era-mid-to-long-term-follow-up/. Accessed .

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