SLR - August 2014 - Matt Borns
Reference: Daniels TR, et al. Intermediate-Term Results of Total Ankle Replacement and Ankle Arthrodesis: a COFAS Multicenter Study. J Bone Joint Surg Am. 2014; 96: 135-42.
Scientific Literature Review
Reviewed By: Matt Borns, DPM
Residency Program: Southern Arizona VA Health Care System
Podiatric Relevance: End-stage ankle arthritis causes joint deformity, disability, loss of income, and has an effect on quality of life. Surgical treatments for end-stage ankle arthritis include ankle replacement and ankle arthrodesis with the hypothesis that patient-reported clinical outcomes would be similar for both procedures.
Methods: Patients in the Canadian Orthopaedic Foot and Ankle Society (COFAS) Prospective Ankle Reconstruction Database were treated with total ankle replacement (involving Agility, STAR, Mobility, or HINTEGRA prostheses) or ankle arthrodesis by six subspecialty-trained orthopaedic surgeons at four centers between 2001 and 2007. Data collection included demographics, comorbidities, and the Ankle Osteoarthritis Scale (AOS) and Short Form-36 (SF-36) scores. The preoperative and latest follow-up scores for patients with at least four years of follow-up were analyzed. Sensitivity analyses excluded ankles that had undergone revision. A linear mixed-effects regression model compared scores between the groups, adjusting for age, sex, side, smoking status, body mass index, inflammatory arthritis diagnosis, baseline score, and surgeon.
Results: Of the 388 ankles (281 in the ankle replacement group and 107 in the arthrodesis group), 321 (83 percent; 232 ankle replacements and eighty-nine arthrodeses) were reviewed at a mean follow-up of 5.5 ± 1.2 years. Patients treated with arthrodesis were younger, more likely to be diabetic, less likely to have inflammatory arthritis, and more likely to be smokers. Seven (7%) of the arthrodeses and forty-eight (17 percent) of the ankle replacements underwent revision. The major complications rate was 7 percent for arthrodesis and 19 percent for ankle replacement. The AOS total, pain, and disability scores and SF-36 physical component summary score improved between the preoperative and final follow-up time points in both groups. The mean AOS total score improved from 53.4 points preoperatively to 33.6 points at the time of follow-up in the arthrodesis group and from 51.9 to 26.4 points in the ankle replacement group. Differences in AOS and SF-36 scores between the arthrodesis and ankle replacement groups at follow-up were minimal after adjustment for baseline characteristics and surgeon.
Conclusions: Intermediate-term clinical outcomes of total ankle replacement and ankle arthrodesis were comparable in a diverse cohort in which treatment was tailored to patient presentation; rates of reoperation and major complications were higher after ankle replacement.