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Comparison of total ankle replacement, ankle arthrodesis finds equivalent results
Investigators found better Ankle Osteoarthritis Scale and SF-36 scores among fusion patients, but adjusting for baseline scores led to equal results.
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Researchers at four Canadian centers found equivalent results for patients that underwent either total ankle replacement or ankle fusion for end-stage ankle arthritis, according to a recent presentation.
“Both operations have the capacity to provide good results where appropriate selection has been made,” Timothy R. Daniels, MD, FRCSC, said.
The researchers conducted a retrospective cohort study using prospectively collected data in the Canadian Orthopaedic Foot and Ankle Society ankle reconstruction database.
Daniels and colleagues studied 366 patients who failed conservative treatment for end-stage ankle arthritis. The index operations were performed before July 31, 2007, Daniels reported, with Ankle Osteoarthritis Scale (AOS), SF-36 and the need for revision surgery as the outcome measures.
Twenty-two patients were lost to follow-up. Of those remaining, 267 patients underwent total ankle replacement (TAR) and 99 patients underwent fusion. The average follow-up was 5 years.
Ankle replacement had similar outcomes to fusion 5 years after surgery.
Images: Daniels TR
Patients who underwent TAR fared better than patients with a fusion concerning AOS postoperative pain, the postoperative disability score and SF-36 physical scores, according to Daniels.
The revision rate was 14% for TAR and 7% for fusion, with fusion revision occurring within 2.5 years of the initial procedure. The revision rate for TAR remained constant throughout follow-up.
When the researchers adjusted for baseline characteristics or SF-36 or AOS scores, they found no statistically significant differences between the groups.
“Our midterm outcomes in total ankle replacement and fusions were equivalent in a diverse cohort of patients when treatment was tailored to the patient by six surgeons [at] four sites across the country,” Daniels said.
“The ankle fusions were performed open or arthroscopically, with no standard approach, using modern techniques that included removal of tibiotalar cartilage and penetration of subchondral bone, addition of autologous or bone graft substitute, and rigid internal fixation with compression,” Daniels said.
TAR was performed using one of four prostheses: the Agility or Mobility prostheses manufactured by DePuy Orthopaedics (Warsaw, Ind., USA); the Hintegra prosthesis from Integra LifeSciences, (Plainsboro, N.J., USA); or the STAR prosthesis from Small Bone Innovations (Morrisville, Pa., USA). – by Renee Blisard Buddle
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Disclosure: Daniels conducts paid presentations for, is a paid consultant to and receives research support from BioMimetic, Carticept and Integra.