Is it Safe to Offer Total Ankle Replacement (TAR) Surgery in Patients with Type II Diabetes?

Abstract

Category: Ankle; Ankle Arthritis; Diabetes; Midfoot/Forefoot Introduction/Purpose: The indications for Total Ankle Replacement (TAR) in patients with Type II Diabetes mellitus is poorly defined and there is paucity of literature reporting clinical, radiological and patient reported outcomes for TAR in this patient group. We aimed to explore the ideal pre-operative criteria for TAR in patients with Type II DM based on results from our center. Methods: We studied the x-rays, clinical findings and patient reported outcomes of surgery at pre-op and 5 years for patients who underwent a total ankle replacement at our center between 2006 and 2014 who had Type II DM. This was a retrospective study. The above findings were also compared between patients who had Type II DM vs. who were not diabetic. Pre-operative screening for diabetic patients included Hb1Ac levels, clinical reporting of swelling, warmth, erythema findings, neurovascular status including proprioception, vibration and neuro filament tests. Statistical analysis of WOMAC and SF-36 scores and differences between diabetic and non-diabetic patients were calculated using General Linear Model - repeated measures ANOVA. Patient satisfaction was analyzed using chi-square test. Rates of superficial and deep infection as well as revision were recorded. Results: Of 230 patients, 9 (3.9%) were diabetic. Pre-op radiographic analysis showed features confining to OA; x-ray, CT scan showed no signs of bone debris, fragmentation per articular fractures. Talus was not translated, no evidence of OA in Subtalar or Talonavicular joint. At 5 years, there was no implant subsidence, loosening, migration or peri-prosthetic cysts; hind and midfoot joints had no features of diabetic arthropathy/collapse. Comparing outcomes to Non-diabetic TAR patients, WOMAC & SF-36 scores showed significant (p<0.05) improvement and no significant difference between groups from pre-op to 5 years. In the diabetic group there was 1 superficial infection (11%) 1 deep infection that required revision (11%) compared to 30 superficial infections (13.6%), 1 deep infection (0.5%) and 12 revisions (5.4%) in the non-diabetic group. Conclusion: Painful end stage OA in Type II DM can be treated by TAR, taking into consideration the inclusion and exclusion criteria that we have used in our series.