Abstract
Submission Type:
Ankle Arthritis
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
Weight-bearing protocols post tibiotalar arthrodesis via internal fixation methods vary considerably. Extended non-weightbearing postoperatively may protect the bone fixation but may result in greater complications and suboptimal patient outcomes. This systematic review and meta-analysis aimed to compare union rates and complications as well as functional outcomes of early weight-bearing (EWB < 6 weeks non-weight-bearing) versus late weight-bearing (LWB ≥ 6 weeks) following ankle fusion using internal fixation.
Methods:
We performed a systematic review and meta-analysis of cohort and comparative studies using five databases. We included all studies that documented the post operative weight-bearing protocol following internal fixation of the tibiotalar joint (excluding Charcot arthropathy, failed ankle arthrodesis or revised total ankle replacement). Greater than 50% tibiotalar trabecular surface area radiographically suggested union and the American Orthopaedic Foot and Ankle Score (AOFAS) determined functional outcomes. Risk of bias was assessed using MINORS. Data extraction was performed with Covidence online software and the meta-analysis by using RStudio.
Results:
This systematic review included 97 cohort or comparative studies. Values for relative risk indicated no significant effect of EWB compared to LWB for joint union following tibiotalar arthrodesis. There was also no significant risk outcome for either major or minor complications between these protocols. Patients reported positive outcomes (as early as three weeks after surgery) following both procedures with no significant between-group differences.
Conclusion:
Based on the studies reviewed, early weight-bearing following tibiotalar fusion via internal fixation does not appear to affect union or complication rates for patient rehabilitation. An early weight-bearing protocol may be associated with improved functional outcomes as limited consequences were reported.