Functional Limitations of Patients with End-Stage Ankle Arthrosis

Abstract

Background: Arthritis and other rheumatic conditions are the leading causes of disability among adults in the United States. The purpose of this report was to describe the self-reported functional limitations of a group of patients with end-stage ankle arthrosis. Method: Patients who presented for operative management of end-stage ankle arthrosis at the University of Minnesota and Harborview Medical Center completed a Musculoskeletal Functional Assessment (MFA) as part of their preoperative clinical evaluation. Data from patients evaluated during the time period April, 1995, through May, 2004, were used for this project. Results: Four hundred and twenty-six patients with the diagnosis of end-stage ankle arthrosis completed baseline questionnaires. Six of the 426 patients received care on both ankles during the time of this project. The average age of patients at the time of completion of the questionnaire was 56.7 years. There were 241 men and 185 women. The primary underlying causes identified by the treating surgeon at the time of surgery were primary osteoarthritis with no known prior trauma (66), previous trauma (tibial fracture, foot fractures, or ankle ligamentous disruption) (296), rheumatoid arthritis (24), no known cause (21), and a variety of diseases or infections (19). In all domains, the patients with end-stage ankle arthrosis showed statistically significant differences from a general population sample. Conclusions: The effects of ankle arthritis as demonstrated by this data are severe. Most of these patients were severely limited in function. Without a data-driven understanding of the limitations the patients have, it is difficult to make an effective argument for focused research to solve the problems. Without understanding the patients' needs, it is impossible to assess the effect of treatment. The information in this paper provides a baseline understanding of effect of the current functional limitations of patients with end-stage ankle arthrosis.

Get full access to this article

View all access options for this article.

References

1. Centers for Disease Control: Prevalence of Arthritis, United States, 1997. MMWR. 50: 334–336, 2001.

2. Cole

Kuettner

: Molecular basis for differences between human joints. Cell. Mol. Life Sci. 59: 19–26, 2002.

3. Cushnaghan

Dieppe

: Study of 500 patients with limb joint osteoarthritis. I. Analysis by age, sex, and distribution of symptomatic joint sites. Ann. Rheum. Dis. 50: 8–13, 1991.

4. Demetriades

Strauss

Gallina

: Osteoarthritis of the ankle. Clin. Orthop. 349: 28–42, 1998.

5. Engelberg

Martin

Agel

et al.: Musculoskeletal function assessment instrument: Criterion and construct validity. J. Orthop. Res. 14: 182–192, 1996.

6. Engelberg

Martin

Agel

Swiontkowski

: Musculoskeletal function assessment: reference values for patient and non-patient samples. J. Orthop. Res. 17: 101–109, 1999.

7. Hannan

: Epidemiologic perspectives on women and arthritis: an overview. Arthritis Care Res. 9: 424–434, 1996.

8. Huch

Kuettner

Dieppe

: Osteoarthritis in ankle and knee joints. Semin. Arthritis Rheum. 26: 667–674, 1997.

9. Koepp

Eger

Muehleman

et al.: Prevalence of articular cartilage degeneration in the ankle and knee joints of human organ donors. J. Orthop. Sci. 4: 407–412, 1999.

10.

10. Lawrence

Helmick

Arnett

et al.: Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 41: 778–799, 1998.

11.

11. Martin

Engelberg

Agel

Snapp

Swiontkowski

: Development of a musculoskeletal extremity health status instrument: the Musculoskeletal Function Assessment instrument. J. Orthop. Res. 14: 173–181, 1996.

12.

12. Martin

Engelberg

Agel

Swiontkowski

: Comparison of the Musculoskeletal Function Assessment Questionnaire with the Short Form-36, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Sickness Impact Profile Health-Status measures. J. Bone Joint Surg. 79-A: 1323–1335, 1997.

13.

13. Meachim

: Cartilage fibrillation at the ankle joint in Liverpool necropsies. J. Anat. 119: 601–610, 1975.

14.

14. Muehleman

Bareither

Huch

et al.: Prevalence of degenerative morphological changes in the joints of the lower extremity. Osteoarth. Cart. 5 (1): 23–37, 1997.

15.

15. Slater

Bales

: Arthritis, osteoporosis, and chronic back conditions. CDC, Healthy People 2010; 2002.

16.

16. Thomas

Daniels

: Ankle arthritis. J. Bone Joint Surg. 85-A: 923–936, 2003.

17.

17. Treppo

Koepp

Quan

et al.: Comparison of biomechanical and biochemical properties of cartilage from human knee and ankle pairs. J. Orthop Res. 18: 739–748, 2000.

18.

18. World Health Organization: The burden of musculoskeletal conditions at the start of the new millennium-Report of a WHO Scientific Group: World Health Organization; 2003.