Long-term follow up of TAR in patients with juvenile idiopathic arthritis

J.G. Kimani, C. Loizou, R. Brown, B. Sharp, A. Kendal

Background: Juvenile idiopathic arthritis (JIA) is a chronic immune-mediated arthropathy characterised by its earlyonset and multi-joint involvement. Ankle arthritis secondary to JIA is functionally debilitating. In those patients with end-stage disease, the surgical options include ankle arthroplasty or fusion. Total ankle replacement (TAR) has the perceived advantage of maintaining ankle-hindfoot movement in a patient group with widespread joint involvement.

Methods: We performed a single centre study of all patients with JIA receiving a TAR since 2000. The primary outcome measure was revision surgery. Secondary outcome measures included radiographic evidence of failure and PROMS.

Result: 26 TAR (12 Mobility and 14 STAR) were performed in 17 patients with JIA (mean age 40.4 years; range 21-63). There was radiographic evidence of failure in 50% of TAR. Typically TAR failed with total talar collapse. 31% of TAR were surgically revised to fusion in all but one case. The 10 and 15 year survival rates were 70% and 30%, respectively. Radiographic failure was associated with a raised MOXFQ score (median = 43) compared to patients with normal TAR radiographs (median = 33.5) and those that underwent revision (median = 35.5). Despite 77% of TAR for JIA remaining painful, 86% reported an improvement in pain post-TAR and 71% would recommend the operation to a friend/family member with the same condition. In a global assessment of joints, 48% rated it as “one of their better joints”.

Conclusion: TAR in the context of JIA is associated with high rates of radiographic failure (including talar collapse), high revision rates and poor MOXFQ scores. However, patient satisfaction from this treatment remains high in the context of their global joint disease.