Introduction:. Ankle arthritis is a leading cause of pain and disability. The effect of this condition on physical and mental health is similar to end stage hip arthritis. There is paucity of literature on PROMS following total ankle replacements (TAR) in comparison to total hip replacement (THR) or knee replacement (TKR). We aimed to study 5 year outcomes of TAR in comparison with TKR and THR. Methods:. PROMS data from patients who underwent a primary THR, TKR or TAR from March 2003 to 2013 were collected from our hospital patient registry. They were divided into 3 groups based on the type of primary joint replacement. Patient demographics and patient reported outcomes (WOMAC, SF-36 scores and patient satisfaction scores at follow up) were compared at pre-op and 5 year follow up. Results:. There was data available on 1920 THR, 2582 TKR and 248 TAR patients. Pre-operatively, TAR patients reported higher function scores when compared to THR and TKR (40.2 vs. 34.2 and 35.8; p<0.05). For SF-36 scores, there was no difference between groups for general health, role emotional components (P>0.05); TAR patients reported similar scores to TKRs for physical domains; to THRs for the mental domains (P>0.05). At 5 years post-op, TARs reported lower scores than THRs and TKRs for function and stiffness. For SF-36 scores, TARs reported similar outcomes to THR and TKR for mental health components (p>0.05), similar scores to TKR for 3/4 physical domains (p<0.05), but lower satisfaction rates for ADL and recreation when compared to THR (P<0.05). Conclusion:. TAR patients had similar outcomes to THR or TKR patients for disease specific and mental health domains, and lower patient satisfaction rates in terms of pain relief, ADL and recreation. Further research is warranted including clinical outcomes along with PROMS with a long term follow up

Clinicians are often asked by patients, “When can I drive again?” after lower limb injury or surgery. This question is difficult to answer in the absence of any guidelines. This review aims to collate the currently available evidence and discuss the factors that influence the decision to allow a patient to return to driving. Medline, Web of Science, Scopus, and EMBASE were searched using the following terms: ‘brake reaction time’, ‘brake response time’, ‘braking force’, ‘brake pedal force’, ‘resume driving’, ‘rate of application of force’, ‘driving after injury’, ‘joint replacement and driving’, and ‘fracture and driving’. Of the relevant literature identified, most studies used the brake reaction time and total brake time as the outcome measures. Varying recovery periods were proposed based on the type and severity of injury or surgery. Surveys of the Driver and Vehicle Licensing Agency, the Police, insurance companies in the United Kingdom and Orthopaedic Surgeons offered a variety of opinions.

There is currently insufficient evidence for any authoritative body to determine fitness to drive. The lack of guidance could result in patients being withheld from driving for longer than is necessary, or returning to driving while still unsafe.

Cite this article: Bone Joint J 2013;95-B:290–4.

The aim of this study was to identify the incidence of post-operative symptomatic deep-vein thrombosis (DVT), as well as the risk factors for and location of DVT, in 665 patients (701 ankles) who underwent primary total ankle replacement. All patients received low-molecular-weight heparin prophylaxis. A total of 26 patients (3.9%, 26 ankles) had a symptomatic DVT, diagnosed by experienced radiologists using colour Doppler ultrasound. Most thrombi (22 patients, 84.6%) were localised distally in the operated limb. Using a logistic multiple regression model we identified obesity, a previous venous thromboembolic event and the absence of full post-operative weight-bearing as independent risk factors for developing a symptomatic DVT.

The incidence of symptomatic DVT after total ankle replacement and use of low-molecular-weight heparin is comparable with that in patients undergoing total knee or hip replacement.