Etiology of Ankle Osteoarthritis

  • Victor Valderrabano
  • Monika Horisberger
  • Iain Russell
  • Hugh Dougall
  • Beat Hintermann
Original Article

Abstract

The purpose of this study was to evaluate the distribution rate of etiologies leading to ankle arthritis and to quantify and compare the important clinical and radiologic variables among these etiologic groups. We evaluated data from 390 patients (406 ankles) who consulted our center because of painful end-stage ankle osteoarthritis (OA) by using medical history, physical examination, and radiography. Posttraumatic ankle OA was seen in 78% of the cases (n = 318), secondary arthritis in 13% (n = 52), and primary OA in 9% (n = 36). The average American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was 38 points (range, 0–74 points), range of motion was 22° (range, 0°−65°), and visual analog scale for pain was 6.8 (range, 2–10). Patients with posttraumatic end-stage ankle OA were younger than patients with primary OA. The average tibiotalar alignment was 88° (range, 51°–116°) and did not differ between the etiologic groups. Our study showed trauma is the main cause of ankle OA and primary OA is rare. In the majority of patients with ankle OA the average tibiotalar alignment is varus regardless of the underlying etiology.

Level of Evidence: Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Aurich M, Squires GR, Reiner A, Mollenhauer JA, Kuettner KE, Poole AR, Cole AA. Differential matrix degradation and turnover in early cartilage lesions of human knee and ankle joints. Arthritis Rheum. 2005;52:112–119.PubMedCrossRefGoogle Scholar
  2. 2.
    Brown TD, Shaw DT. In vitro contact stress distributions in the natural human hip. J Biomech. 1983;16:373–384.PubMedCrossRefGoogle Scholar
  3. 3.
    Coester LM, Saltzman CL, Leupold J, Pontarelli W. Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am. 2001;83:219–228.PubMedGoogle Scholar
  4. 4.
    DeCoster TA, Willis MC, Marsh JL, Williams TM, Nepola JV, Dirschl DR, Hurwitz SR. Rank order analysis of tibial plafond fractures: does injury or reduction predict outcome? Foot Ankle Int. 1999;20:44–49.PubMedGoogle Scholar
  5. 5.
    Eger W, Schumacher BL, Mollenhauer J, Kuettner KE, Cole AA. Human knee and ankle cartilage explants: catabolic differences. J Orthop Res. 2002;20:526–534.PubMedCrossRefGoogle Scholar
  6. 6.
    Elgafy H, Ebraheim NA, Tile M, Stephen D, Kase J. Fractures of the talus: experience of two level 1 trauma centers. Foot Ankle Int. 2000;21:1023–1029.PubMedGoogle Scholar
  7. 7.
    Felson DT. The epidemiology of osteoarthritis: prevalence and risk factors. In: Kuettner KE, Goldberg VM, eds. Osteoarthritis Disorders. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1995:13–24.Google Scholar
  8. 8.
    Gelber AC, Hochberg MC, Mead LA, Wang NY, Wigley FM, Klag MJ. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med. 2000;133:321–328.PubMedGoogle Scholar
  9. 9.
    Gunther KP, Sturmer T, Sauerland S, Zeissig I, Sun Y, Kessler S, Scharf HP, Brenner H, Puhl W. Prevalence of generalised osteoarthritis in patients with advanced hip and knee osteoarthritis: the Ulm Osteoarthritis Study. Ann Rheum Dis. 1998;57:717–723.PubMedCrossRefGoogle Scholar
  10. 10.
    Harrington KD. Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability. J Bone Joint Surg Am. 1979;61:354–361.PubMedGoogle Scholar
  11. 11.
    Hashimoto T, Inokuchi S. A kinematic study of ankle joint instability due to rupture of the lateral ligaments. Foot Ankle Int. 1997;18:729–734.PubMedGoogle Scholar
  12. 12.
    Huch K, Kuettner KE, Dieppe P. Osteoarthritis in ankle and knee joints. Semin Arthritis Rheum. 1997;26:667–674.PubMedCrossRefGoogle Scholar
  13. 13.
    Ihn JC, Kim SJ, Park IH. In vitro study of contact area and pressure distribution in the human knee after partial and total meniscectomy. Int Orthop. 1993;17:214–218.PubMedCrossRefGoogle Scholar
  14. 14.
    Jaakkola JI, Mann RA. A review of rheumatoid arthritis affecting the foot and ankle. Foot Ankle Int. 2004;25:866–874.PubMedGoogle Scholar
  15. 15.
    Kang Y, Koepp H, Cole AA, Kuettner KE, Homandberg GA. Cultured human ankle and knee cartilage differ in susceptibility to damage mediated by fibronectin fragments. J Orthop Res. 1998;16:551–556.PubMedCrossRefGoogle Scholar
  16. 16.
    Kimizuka M, Kurosawa H, Fukubayashi T. Load-bearing pattern of the ankle joint: contact area and pressure distribution. Arch Orthop Trauma Surg. 1980;96:45–49.PubMedCrossRefGoogle Scholar
  17. 17.
    Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349–353.PubMedGoogle Scholar
  18. 18.
    Knupp M, Ledermann H, Magerkurth O, Hinterman B. The surgical tibiotalar angle: a radiologic study. Foot Ankle Int. 2005;26:713–716.PubMedGoogle Scholar
  19. 19.
    Koralewicz LM, Engh GA. Comparison of proprioception in arthritic and age-matched normal knees. J Bone Joint Surg Am. 2000;82:1582–1588.PubMedGoogle Scholar
  20. 20.
    Lindsjö U. Operative treatment of ankle fracture-dislocations: a follow-up study of 306/321 consecutive cases. Clin Orthop Relat Res. 1985;199:28–38.PubMedGoogle Scholar
  21. 21.
    Lofvenberg R, Karrholm J, Lund B. The outcome of nonoperated patients with chronic lateral instability of the ankle: a 20-year follow-up study. Foot Ankle Int. 1994;15:165–169.PubMedGoogle Scholar
  22. 22.
    Marsh JL, Buckwalter J, Gelberman R, Dirschl D, Olson S, Brown T, Llinias A. Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg Am. 2002;84:1259–1271.PubMedGoogle Scholar
  23. 23.
    Martin JA, Ellerbroek SM, Buckwalter JA. Age-related decline in chondrocyte response to insulin-like growth factor: I. The role of growth factor binding proteins. J Orthop Res. 1997;15:491–498.PubMedCrossRefGoogle Scholar
  24. 24.
    Melton LJ III, Khosla S, Crowson CS, O’Connor MK, O’Fallon WM, Riggs BL. Epidemiology of sarcopenia. J Am Geriatr Soc. 2000;48:625–630.PubMedGoogle Scholar
  25. 25.
    Monroe MT, Beals TC, Manoli A. Clinical outcome of arthrodesis of the ankle using rigid internal fixation with cancellous screws. Foot Ankle Int. 1999;20:227–231.PubMedGoogle Scholar
  26. 26.
    Mont MA, Sedlin ED, Weiner LS, Miller AR. Postoperative radiographs as predictors of clinical outcome in unstable ankle fractures. J Orthop Trauma. 1992;6:352–357.PubMedCrossRefGoogle Scholar
  27. 27.
    Morrey BF, Wiedeman GP Jr. Complications and long-term results of ankle arthrodeses following trauma. J Bone Joint Surg Am. 1980;62:777–784.PubMedGoogle Scholar
  28. 28.
    Okuda R, Kinoshita M, Morikawa J, Yasuda T, Abe M. Arthroscopic findings in chronic lateral ankle instability: do focal chondral lesions influence the results of ligament reconstruction? Am J Sports Med. 2005;33:35–42.PubMedCrossRefGoogle Scholar
  29. 29.
    Peyron JG. The epidemiology of osteoarthritis. In: Moskowitz RW, Howell DS, Goldberg VM, Mankin HJ, eds. Osteoarthritis. Diagnosis and Treatment. Philadelphia, PA: WB Saunders; 1984:9–27.Google Scholar
  30. 30.
    Phillips WA, Schwartz HS, Keller CS, Woodward HR, Rudd WS, Spiegel PG, Laros GS. A prospective, randomized study of the management of severe ankle fractures. J Bone Joint Surg Am. 1985;67:67–78.PubMedGoogle Scholar
  31. 31.
    Puno RM, Vaughan JJ, Stetten ML, Johnson JR. Long-term effects of tibial angular malunion on the knee and ankle joints. J Orthop Trauma. 1991;5:247–254.PubMedCrossRefGoogle Scholar
  32. 32.
    Ruedi T. Fractures of the lower end of the tibia into the ankle joint: results 9 years after open reduction and internal fixation. Injury. 1973;5:130–134.PubMedCrossRefGoogle Scholar
  33. 33.
    Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, Amendola A. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J. 2005;25:44–46.PubMedGoogle Scholar
  34. 34.
    Seitz WH, Andrews DL, Shelton ML, Feldman F. Triplane fractures of the adolescent ankle: a report of three cases. Injury. 1985;16:547–553.PubMedCrossRefGoogle Scholar
  35. 35.
    Shepherd DE, Seedhom BB. Thickness of human articular cartilage in joints of the lower limb. Ann Rheum Dis. 1999;58:27–34.PubMedCrossRefGoogle Scholar
  36. 36.
    Stamatis ED, Cooper PS, Myerson MS. Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint. Foot Ankle Int. 2003;24:754–764.PubMedGoogle Scholar
  37. 37.
    Stauffer RN, Chao EY, Brewster RC. Force and motion analysis of the normal, diseased, and prosthetic ankle joint. Clin Orthop Relat Res. 1977;127:189–196.PubMedGoogle Scholar
  38. 38.
    Taga I, Shino K, Inoue M, Nakata K, Maeda A. Articular cartilage lesions in ankles with lateral ligament injury: an arthroscopic study. Am J Sports Med. 1993;21:120–126.PubMedCrossRefGoogle Scholar
  39. 39.
    Takakura Y, Takaoka T, Tanaka Y, Yajima H, Tamai S. Results of opening-wedge osteotomy for the treatment of a post-traumatic varus deformity of the ankle. J Bone Joint Surg Am. 1998;80:213–218.PubMedCrossRefGoogle Scholar
  40. 40.
    Thomas RH, Daniels TR. Current concepts review: ankle arthritis. J Bone Joint Surg Am. 2003;85:923–936.PubMedGoogle Scholar
  41. 41.
    Treppo S, Koepp H, Quan EC, Cole AA, Kuettner KE, Grodzinsky AJ. Comparison of biomechanical and biochemical properties of cartilage from human knee and ankle pairs. J Orthop Res. 2000;18:739–748.PubMedCrossRefGoogle Scholar
  42. 42.
    Wyrsch B, McFerran MA, McAndrew M, Limbird TJ, Harper MC, Johnson KD, Schwartz HS. Operative treatment of fractures of the tibial plafond: a randomized, prospective study. J Bone Joint Surg Am. 1996;78:1646–1657.PubMedGoogle Scholar
  43. 43.
    Wyss C, Zollinger H. The causes of subsequent arthrodesis of the ankle joint. Acta Orthop Belg. 1991;57(suppl 1):22–27.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Victor Valderrabano
    • 1
    • 2
    • 3
  • Monika Horisberger
    • 1
  • Iain Russell
    • 3
  • Hugh Dougall
    • 3
  • Beat Hintermann
    • 4
  1. 1.Department of OrthopaedicsUniversity of Basel, University Hospital of BaselBaselSwitzerland
  2. 2.Human Performance LaboratoryUniversity of Calgary Calgary Canada
  3. 3.Department of OrthopaedicsUniversity of CalgaryCalgaryCanada
  4. 4.Department of OrthopaedicsCantonal Hospital LiestalLiestalSwitzerland

Personalised recommendations