Total Ankle Arthroplasty Versus Ankle Arthrodesis: Comparison of Sports, Recreational Activities and Functional Outcome

SLR- January 2014- David Waters

Reference: Schuh R, Hofstaetter J, Krismer M, Bevoni R, Windhager R, Trnka HJ. Total Ankle Arthroplasty Versus Ankle Arthrodesis: Comparison of Sports, Recreational Activities and Functional Outcomes. International Orthopaedics.  2012;  36(6): 1207 – 1214.

 

Scientific Literature Review

Reviewed By: David Waters, DPM

Residency Program: St John Hospital and Medical Center

Podiatric Relevance: End stage osteoarthritis is a painful and sometimes debilitating condition. Debate continues as to whether total ankle arthroplasty or ankle arthrodesis should be the treatment of choice. The goal of both procedures is to decrease pain and provide a plantigrade foot to enable the patient to return to pain free activity. Ankle arthrodesis has been the mainstay of surgical treatment, however, multiple attempts have been made at total ankle arthroplasty with the hypothesis that maintaining the ankle joint range of motion will further maintain the functional kinematics of the foot. The study looks at the functional ability of patients both pre- and postoperatively who underwent ankle arthrodesis or total ankle arthroplasty. Function was determined by the patient’s ability to return to preoperative functional levels as it relates to sports and recreational activities.
 

Methods: A total of 41 patients (21 ankle arthrodesis [AAD] and 20 TAR) were examined at 34.5 months post operatively. At follow up pre- and post-operative participation in sports and recreational activities were assessed. Post-operative activity levels were determined using the ankle activity score according to Halasi et al and the UCLA activity scale. Post-operative clinical and functional outcome were assessed using the AOFAS hindfoot score. The percentage of patients participating in sports and recreational activities, UCLA score and AOFAS score were compared between both treatment groups.

Results: 86 percent of patients were active in sports pre-operatively in the AAD group. Seventy-six of patients were active in sports in the TAR group. Seventy-six of patients in both groups were active in sports postoperatively (p = 0.08). The UCLA score was 7 in the AAD group and 6.8 in the TAR group (p = 0.78). The AOFAS score reached 75.6 in the AAD group and 75.6 in the TAR group (p =0.97). The AOFAS sub-scores for pain, function, and alignment were not significant. The ankle activity score decrease was significant for both groups(p = 0.047). 

Conclusions: Indications for AAD or TAR include pain and loss of function of the ankle joint. Accordingto this retrospective study, both procedures have the ability to relieve pain and restore function to the patient. Neither procedure is statistically better than the other. The study does have some limitations due to its retrospective nature, the fact the AOFAS and UCLA score were not recorded preoperatively. Despite these inherent weaknesses the study does show both procedures to beviable options in the treatment of end stage osteoarthritis of the ankle.