Diabetes is a growing public health concern with 380 million people worldwide projected to have the disease by 2025. With over 1% of the world’s population having ankle arthritis, many diabetic patients will require operative treatment. Modern total ankle replacement (TAR) systems have grown in popularity due to improvements in implant design and surgical technique.   Traditionally, TARs have been limited to patients who are healthy, older, and without medical conditions such as obesity and diabetes.

Orthopaedic Foot and Ankle Surgeons at Duke University recently reviewed 813 TARs performed at their institution over the past 11 years. We compared all diabetic TAR patients to a group of TAR patients without the disease. We found that the diabetic patients smoked more and were, on average, heavier, sicker, and older. However, despite these demographic differences, there were no differences in infections, secondary procedures, failure rates, or revisions. At two years, both groups had improvements in all functional and pain outcome scores. In fact, there were no differences between the groups in either the amount of pain relief or improvement of function scores at two years.

We conclude that total ankle replacement can be effective and safe in improving function and decreasing pain in patients with diabetes. Even despite some important demographic differences, diabetic patients did not have an increased rate of post-operative infection or revision surgery. Diabetic and nondiabetic patients can expect similar improvements in performing recreational activities and activities of daily living and similar decreases in pain after a total ankle replacement.

Christopher Gross
Assistant Professor
Medical University of South Carolina
Department of Orthopaedics, Charleston, SC

Publication

Impact of Diabetes on Outcome of Total Ankle Replacement.
Gross CE, Green CL, DeOrio JK, Easley M, Adams S, Nunley JA 2nd
Foot Ankle Int. 2015 Oct

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