BackgroundIn the late stage of traumatic ankle arthritis, the pain symptoms are aggravated and the joint function is obviously limited. However, in the face of young patients with high activity requirements, there are still great challenges in how to preserve the joint and effectively treat traumatic ankle arthritis. Ankle distraction arthroplasty and supramalleolar osteotomy are both options for such medical condition, but the studies comparing their clinical outcomes have been scarce. The

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... ose of this study is to compare the clinical outcomes of ankle distraction arthroplasty and supramalleolar osteotomy in the treatment of severe traumatic ankle arthritis in young adult patients.MethodsThis was designed a retrospective study, enrolling 73 consecutive young adult patients who underwent ankle distraction arthroplasty (n=32) or supramalleolar osteotomy (n=41) for post-traumatic ankle arthritis from January 2017 to December 2020. All patients had at least 24-month follow-ups. The outcome measures were the comparisons of the pre- and postoperative visual analog scale (VAS) for pain relief, the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, angle range of motion (ROM), complications, patient-rated overall satisfaction and radiological evaluation of changes in ankle joint space width (JSW).ResultsSeventy-three patients (73 ankles) (100%) returned for final evaluation at an average of 32 months (range, 24 to 48 months) follow-up. At an average of 6 months follow-up, both groups achieved significantly improved VAS, AOFAS, ROM and JSW scores compared to those at baseline ( p<0.05), but not significantly differed between groups (all p>0.05). Either, both groups did not differ in in the tibial anterior surface angle(TAS), talar tilt angle(TT), tibial lateral surface angle(TLS), except for the correcting the load-bearing line of the ankle and hindfoot. However, at the last follow-up, patient satisfaction and ankle function scores in the ankle distraction arthroplasty group showed a downward trend, while the function scores in the supramalleolar osteotomy group showed an increasing trend, which was statistically significant.ConclusionsBoth ankle distraction arthroplasty and supramalleolar osteotomy are effective treatment options for the severe post-traumatic ankle arthritis in the young adult patients. From the long-term follow-up, however, supramalleolar osteotomy is better than ankle distraction arthroplasty in ankle score and patient satisfaction evaluation.Level of evidence: Level III, retrospective comparative series.