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Better AAOS outcomes found with TAR, arthroscopic ankle fusion vs. open fusion
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In a study to compare total ankle replacement, arthroscopic ankle fusion and open ankle fusion in patients with isolated non-deformed end-stage ankle arthritis, researchers discovered arthroscopic fusion had results similar to ankle replacement and that open fusion had the worst outcomes.
“Based on the [American Academy of Orthopaedic Surgeons] AAOS total pain and difficulty and change scores, total ankle replacement and arthroscopic ankle fusion have significantly higher outcomes than open ankle arthrodesis in this non-deformed cohort. Arthroscopic ankle fusion and open ankle fusion have significantly less revision and reoperation than total ankle replacement. However, total ankle replacement and arthroscopic ankle fusion are relatively equal options for the treatment of end-stage type 1 ankle arthritis in regards to outcome,” Andrea N. Veljkovic, MD, BComm, FRCSC, said during a recent presentation.
In their database study, Veljkovic and her colleagues prospectively followed 88 total ankle replacements (TARs), 50 arthroscopic ankle fusions and 100 open ankle fusions for an average of 3.57 years. All three procedures improved patient outcomes.
“There was more reoperation about the ankle for total ankle replacement; however, when you look at revision itself, there is a trend toward total ankle replacement and open ankle arthrodesis having similar revision rates,” Veljkovic said.
When the results were analyzed for significant reoperation, there were higher rates for TAR. After controlling for variables, the findings again showed more reoperations for the TAR group.
Both TAR and arthroscopic ankle fusion fared better for AAOS total change score, AAOS pain difference and AAOS difficulty difference vs. open ankle fusion.
A comparison of arthroscopic and open ankle fusion, showed better AAOS total change scores, AAOS pain difference and difficulty difference in the arthroscopy group; but there was no significant difference between the cohorts for reoperation.
TAR had better results for AAOS total difference, pain difference and difficult difference scores compared with open ankle arthrodesis. The TAR and open arthrodesis groups had shorter survivorship than the arthroscopic cohort.
“The premise of what we found was what we presumed, that if we did minimally invasive arthroscopic procedures, likely [patients] would have less complications, higher patient satisfaction and less scarring,” Veljkovic told Orthopedics Today. “The interesting thing is, from a standpoint of replacement, although there were higher revision rates and higher reoperations, the patients had good self-reported outcomes — almost equal to the arthroscopic ankle fusion.”
She added, “Clinical implications are that likely for ankle arthritis, the better procedure would be arthroscopic ankle fusion or ankle replacement. However, the rate of revision and reoperation is higher in total ankle replacement. It is unknown whether this will have any effect on final patient outcomes, specifically if patients are aware that reoperation is a possibility in the course of their treatment in order to maximize longevity of the index procedure. Further study in the form of an RCT is warranted to better examine the findings of this prospective study.” – by Casey Tingle
Reference:
Veljkovic AN, et al. Comparison of outcome in isolated non-deformed end-stage ankle arthritis between ankle replacement, arthroscopic ankle fusion, and open ankle fusion. Presented at: American Orthopaedic Foot and Ankle Society Annual Meeting; Sept. 21-23, 2014; Chicago.
For more information:
Andrea N. Veljkovic, MD, BComm, FRCSC, can be reached at the University of Toronto, Department of Surgery, 27 King’s College Cir., Toronto, ON M5S, Canada; email: docveljkovic@yahoo.com.
Disclosure: Veljkovic reports no relevant financial disclosures.