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New combined TAA procedure shows promising results for pantalar arthritis
However, investigators found high early complication, reoperation rates with the procedure.
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DENVER — Combining total ankle arthroplasty with hindfoot fusion may significantly improve pain relief and function for patients with pantalar arthritis, and may lead to results comparable to isolated total ankle arthroplasty.
Kelly L. Apostle, MD, and colleagues compared the short-term outcomes of 73 patients who underwent total ankle arthroplasty (TAA) combined with either subtalar fusion or triple arthrodesis to a matched cohort of 73 patients who had TAA only. The investigators compared the outcomes of both groups preoperatively and at 6, 12 and 24 months postoperative. The average follow-up was 23 months.
During the study, the investigators discovered that both groups showed significant improvements from mean baseline scores on the Ankle Osteoarthritis Scale (AOS) and the physical function and pain subscales of the SF-36. They also found a trend toward improvement for both groups from baseline in Foot Function Index (FFI) scores. They reported no differences between the groups on any of these outcome measures at latest follow-up.
Outcomes
The study revealed 31 complications (32%) in the combined TAA and hindfoot fusion group including 16 major complications. Most of the complications were related to component loosening, Apostle said during her presentation at the American Orthopaedic Foot and Ankle Society 24th Annual Summer Meeting. Three patients in the group had nonunions in the subtalar joint and one patient had a varus malunion.
Twenty-two patients (30%) required reoperation and most were performed for component loosening. Two patients underwent tibiotalocalcaneal fusions; one for a septic complication and the other for an aseptic complication. Another two patients underwent revision for nonunions at the subtalar joint. In addition, one patient had a below-the-knee amputation due to chronic pain.
In the isolated TAA group, the investigators found a 26% reoperation rate and a 42% complication rate. Half of the complications were considered major complications and most were related to component failure.
High complication rate
“We were able to show that patients improved significantly in terms of both pain and function from baseline and that they showed no difference when compared to a cohort of patients undergoing isolated ankle arthroplasty,” Apostle said. “This procedure is associated with a high early complication and reoperation rate.”
However, she noted that the rates were similar to those of published reports for isolated TAA. The nonunion and malunion rates for the combined TAA and hindfoot fusion procedure were also lower than those reported for extended arthrodesis.
Using information from a prospectively gathered database, the investigators identified patients with primary or secondary ankle and hindfoot arthritis who underwent TAA and hindfoot fusion between 1999 and 2007.
“All patients had been operated on by one of four surgeons at one of two institutions using one of four prostheses,” Apostle said. “There was a similar distribution of the four prostheses between the two groups.”
She cited the short-term follow-up and the use of isolated TAA as a control group as study limitations. “Arthroplasty and fusion is associated with a significant risk of an early complication or reoperation,” Apostle said. “However, it improves both pain and function from baseline making it an attractive alternative to extended arthrodesis.”
For more information:
- Kelly L. Apostle, MD, can be reached at University of British Columbia, 910 West 10th Ave., 3rd Floor, Vancouver, BC V5Z 4E3, Canada; 604-875-4192; e-mail: kapostle2005@meds.uwo.ca. Her department received educational support from BioMimetics, Zimmer and Wyeth.
Reference:
- Apostle KL, DiSilvestro M, Younger A, et al. Total ankle arthroplasty combined with hindfoot fusion for the treatment of pantalar arthritis. Presented at the American Orthopaedic Foot and Ankle Society 24th Annual Summer Meeting. June 26-28, 2008. Denver.