SLR- March 2014- Jeff Holmes
Reference: Jacqueline van Heiningen, Thea PM Vliet Vlieland and Huub JL van der Heide. The Mid-Term Outcome of Total Ankle Arthroplasty and Ankle Fusion in Rheumatoid Arthritis: A Systematic Review. BMC Musculoskeletal Disorders 2013, 14:306.
Scientific Literature Review
Reviewed by: Jeff Holmes, DPMResidency Program: Inova Fairfax Hospital
Podiatric Relevance: This article is relevant to podiatric surgeons because of the recent popularity of ankle arthrodesis and arthroplasty. The question the author wants to answer in this article is what are the rheumatoid arthritis (RA) patient outcomes when undergoing ankle arthroplasty or arthrodesis? This is a literature review comparing the effectiveness and safety of ankle arthrodesis and total ankle arthroplasty in RA patients. It compares the third generation ankle implant with isolated fusion of the ankle joint with internal fixation. To date there has been no direct comparison of these two surgical techniques within the RA population.
Methods: The author took studies from January 1980 to June of 2011. Studies were obtained from Pubmed, Embase, Web Science and other manual sources. There were certain inclusion criteria that had to be met, a few of which being >5 RA patients in the study, internal fixation arthrodesis or three component mobile bearing total ankle implant (TAI), ankle scoring system, and original clinical study.
Results: Originally 868 studies were identified. After each study was reviewed only 17 full text articles met the criteria, all with low methodological quality. The effect size concerning total ankle arthroplasty ranged between 1.9 and 6.0, for arthrodesis the effect sizes were 4.0 and 4.7. The findings were consistent with the current literature in that reoperation due to non-union or implant failure was 12 percent and 11 percent respectively.
Conclusions: Currently there are no clinical trials directly comparing ankle arthroplasty or arthrodesis effectiveness in rheumatoid arthritis patients. The studies reviewed did show that both surgical procedures demonstrate similar results.There is currently no superior procedure indicated. The long-term results are still of question. There will need to be long term randomized control trials or sound cohort studies in the future. Patient selection as well as surgical knowledge both need to be evaluated before making the decision of which procedure to perform. One undergoing ankle arthroplasty should have it performed by a surgeon who has years of experience and knowledge of the procedure and product.