Total ankle replacement may be as effective as fusion for end-stage ankle arthritis
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Key takeaways:
- Ankle fusion was associated with more adjunctive hindfoot procedures vs. total ankle replacement.
- Ankle replacement was associated with reduced rates of secondary hindfoot fusion vs. ankle fusion.
Results presented at the American Orthopaedic Foot & Ankle Society Annual Meeting showed total ankle replacement is an effective treatment option for end-stage ankle arthritis.
“On the whole, we feel that total ankle replacement is indeed protective of the other hindfoot joints, which makes sense from what we know biomechanically,” Christopher Trew, BSc(Hons), MBChB, said during his presentation.
Trew and colleagues performed a retrospective review of data on more than 500 ankles that underwent total ankle arthroplasty or ankle fusion performed at a single center in the United Kingdom.
Outcomes measures included the Kellgren-Lawrence grading scale, and patients were followed at an average of 12.6 years in the total ankle group and 12.1 years in the ankle fusion group to account for adjunctive procedures, including injections and fusions.
Trew and colleagues found a statistically significant reduction in adjunctive procedures in the total ankle replacement group vs. the ankle fusion group. According to Trew, 24% of ankle fusions resulted in further hindfoot procedures vs. 14% in the total ankle group. In addition, total ankle replacement was associated with a reduced rate of secondary hindfoot fusion compared with ankle fusion (4% vs. 14%).
In a subanalysis, “almost 10% of ankle fusions had their subtalar joint fused,” according to Trew.
“For those of us who have seen these patients in our clinics, we know that they are miserable,” Trew said. “It is absolutely awful having a rock-solid ankle and subtalar joint, so that is not an insignificant risk of ending up with a pretty poor outcome.”
In terms of reoperation rates, Trew said total ankle replacement and ankle fusion had similar outcomes.
“We would counsel that [total ankle arthroplasty] should be considered equally alongside ankle fusion, if not as the primary option,” he said.
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Trew C, et al. Does arthroplasty really protect the hindfoot? A 13-year retrospective review of 516 cases for further hindfoot procedures following ankle arthrodesis vs. total ankle replacement. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 11-14, 2024; Vancouver, British Columbia, Canada (hybrid meeting).
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