Abstract
Juvenile Chronic Arthritis results in the early degeneration of multiple joints with severe pain and deformity. Treatment of ankle arthritis is complex and ankle replacement is indicated because of adjacent and distant joint involvement.
Materials and Methods
We reviewed 25 total ankle replacements in 13 young adults suffering the generalised consequences of Juvenile Chronic Arthritis (JCA) between 2000 and 2009. 12 had bilateral disease, 20 had anklylosis or prior fusion of the hind- or midfoot, and 16 had substantial fixed inversion of the hindfoot. All had previous prosthetic arthroplasty of between 1 and 15 joints. Surgery comprised corrective triple fusion where required, with staged total ankle arthroplasty at an interval of 3 or more months.
Results
All patients reported significant reduction in pain, and increased mobility with increased stride length, however severe co-morbidity limited the usefulness of routine outcome scores. No ankles have required revision to date.
We noted that the dimensions of the distal tibia and talus are markedly reduced in patients with JCA, and as a result of this and bone fragility, the malleoli were vulnerable to fracture or resection. JCA is also associated with cervical spondilitis and instability, micrognathia, temporomandibula arthritis and crico-arytenoid arthritis, resulting in challenging anaesthesia.
Discussion
As a result of our experience, we recommend preoperative CT scan to confirm whether standard or custom implants are required. We also advocate pre-cannulation of both maleoli to reduce the rate of fractures, and facilitate fixation should this occur.
Conclusion
Surgery for this group of patients requires specialist anaesthetic input as well as surgical skills.
