No Progression of Radiological Adjacent Joint Arthritis Noted in Patients with Type II DM undergoing Total Ankle Replacement: A 5 Year Follow Up Study

Abstract

Category: Ankle; Ankle Arthritis; Diabetes Introduction/Purpose: Total Ankle Arthroplasty [TAR] is a recognized treatment for end stage osteoarthritis. Many of these patients also have Type 2 Diabetes. There is a lack of literature of patients undergoing TAR surgery who belong to this cohort and any available literature has shown negative outcomes in such surgery. We aim to study whether the radiological outcomes of such patients undergoing TAR is different to their non diabetic counterparts performed at our Tertiary center. Methods: We conducted a retrospective study of patients undergoing Total Ankle Replacements between 2006 and 2014. Both patients with Type 2 Diabetes and non-diabetic patients were included. Type 1 Diabetics were excluded. Pre-operative screening of patients included thorough clinical assessment including swelling, warmth, erythema and neurovascular assessment including proprioception, vibration and neuro-filament testing. True AP, lateral X-Ray weight bearing views were obtained. MRI or CT scan was carried out on all patients pre-operatively. Patients were reviewed with X-Ray at 3, 6, and 12 month post operatively. Any radiolucency was defined as gap >2mm between the implant and the bone which was not seen at 3 month post op x-ray. Painful ankle replacement implants were investigated by SPECT CT scan. Results: 9(3.9%) of the 230 patients were diabetic. Pre-operative radiographs revealed disease confined to OA, MRI and CT scans showed no evidence of bone debris, fragmentation of articular surfaces, translation of Talus or symptomatic OA in the Subtalar or Talo-navicular joint requiring treatment. Radiological analysis at 5 years demonstrated no evidence of loosening, implant subsidence, migration or periprosthetic cysts. No x-ray progression of arthritis was noted in the Subtalar, Talo-navicular or midfoot joints in Diabetic patient group. At the latest follow up, no radiological features of Charcot arthropathy was noted in the peri-prosthetic area. Conclusion: Our radiological outcome study has demonstrated that at minimum of 5 years, patients with diabetes who underwent TAR did not show any progression of arthritis in adjacent joints. Our study highlights that in the absence of diabetic neuropathy, it is safe to offer TAR in patients with Type II DM.