Abstract
This project highlights the red flags in postoperative rehabilitation of total ankle replacement (TAR) patients managed with two different postoperative rehab regimes.
20 TAR patients were recruited for a pilot RCT between 2008 and 2011; they were randomized to 2 groups (immobilisation in a below knee plaster cast for 6 weeks vs. early mobilisation following TAR); all patients underwent a graded outpatient Physiotherapy program until 12 weeks postoperatively. Assessments included questionnaires, complications, American Orthopaedic Foot and Ankle Score (AOFAS) done preoperatively, 3 and 6 months after surgery
Results
20 TARs for OA (13) and PTOA (7) took part in the trial. There were 10 patients in each arm of the study. Mean age 61.2 years; mean BMI was 29.4. Of the plaster group, there was 1 incidence of fracture medial malleolus (MM) at 6 weeks after removal of plaster cast, 1 fracture MM at 5 months following walking on the beach, 1 fracture (MM) after completion of outpatient physiotherapy session, and 1 fracture MM of unknown reason at 1 year. Of the early mobilisation group, there was 1 intraoperative fracture of tibia (treated conservatively); 1 fracture MM 6 weeks post-op; 2 fracture MM at 8 weeks post-op. All patients had good clinical outcomes at successive follow up assessments.
Conclusion
These results highlights the need for considering a lighter exercise regime, and re-evaluating patient lifestyle, return to recreational activities and feedback on home exercise programs during planning and execution of each phase of postoperative rehabilitation programs to aid prevention of early fractures in patients following TAR.
