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Arthrodesis preferable to re-arthroplasty after failed ankle prosthesis surgery
Researchers reported revision total ankle replacement was not a better option than ankle fusion after a failed primary total ankle replacement.
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After researchers reviewed more than 140 patients who received a primary total ankle arthroplasty, they concluded if a revision was needed it was better for a patient to receive an ankle fusion instead of a revision total ankle replacement.
“By analyzing nationwide data, revision total ankle replacement does not seem to be superior to ankle fusion after a failed primary total ankle replacement, but larger study groups are needed to better compare the outcomes of the two procedures,” Ilka Kamrad, MD, said at the American Academy of Orthopaedic Surgeons Annual Meeting. “But my message to you is our current data supports that arthrodesis is preferable to re-arthroplasty after a failed ankle prosthesis.”
Swedish Ankle Register results
Kamrad and colleagues looked at 64 patients, who after a primary total ankle replacement (TAR) had their tibial and/or talar component exchanged, and 79 patients who had their primary prosthesis converted to an arthrodesis. The patients were identified in the Swedish Ankle Register, Kamrad said.
The patients’ mean age at revision was 60 years, she said and ages ranged from 25 years to 74 years.
Kamrad and colleagues evaluated ankle function in both groups with the SF-36 and the validated Self-reported Foot and Ankle Score (SEFAS).
For the 64 patients who underwent revision TAR, Kamrad said they required a new revision (re-revision or fusion) after a mean of 26 months. The survival rate of revision TAR for these patients after 5 years was 75% and after 10 years it was 56%.
“Evaluating the scores does not show any significant difference between the two groups. When asking patients about satisfaction with their revised ankles, there was no significant difference between the two groups either,” Kamrad said. “As many as 30% of patients in both groups were either dissatisfied or very dissatisfied with a revised ankle.”
Difference in patient satisfaction
Kamrad said the study showed the functional outcomes were fairly similar in both the fusion and revision TAR groups.
“Patient satisfaction is not better in the revision TAR group as compared to the fusion group,” Kamrad said.
At 1 year to 17 years after revision, the mean SEFAS was 24 in patients with exchanged components still in place and patients revised with arthrodesis had a mean SEFAS of 22.
Sixteen of 29 patients who had their prosthesis still in place were satisfied; 4 patients were neither satisfied nor dissatisfied; and 9 patients were dissatisfied, Kamrad and colleagues wrote in the study. The SF-36 physical function results were a mean of 32 points in patients revised with arthrodesis.
“The benefits of this study is we have nationwide data, but there are limitations. We have no preoperative scores or X-rays; the selection was by us and the study is underpowered,” Kamrad said. – by Robert Linnehan
- Reference:
- Kamrad I. Paper #707. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.
- For more information:
- Ilka Kamrad, MD, can be reached at Clinical and Molecular Osteoporosis Research Unit, Hs33, Inga Marie Nilsson’s St. 22, Sweden; email: ilka.kamrad@skane.se.
Disclosure: Kamrad has no relevant financial disclosures.