SLR - March 2018 - Tyler J. Veldkamp
Reference: Hansen S, Davitt J, Anderson J, Bohay D, Coetzee C, Maskill J, Brage M, Houghton M, Sangeorzan B. Comparison of Treatment Outcomes of Arthrodesis and Two Generations of Ankle Replacement Implants. J Bone Joint Surg Am. 2017 Nov 1;99(21):1792–1800.Scientific Literature Review
Reviewed By: Tyler J. Veldkamp, DPM
Residency Program: Hennepin County Medical Center, Minneapolis, MN
Podiatric Relevance: There has been a rapid increase in the utilization of total ankle replacement (TAR) in the last decade requiring those in podiatry to be knowledgeable, if not experienced, on the subject. The ever-evolving question of whether to fuse or replace the joint is becoming more prominent, especially with the progression of newer generation implants. This study served as a bridge between older and newer implant designs and allowed comparison of two groups; historical versus contemporary implants, along with an arthrodesis cohort.
Methods: This was a prospective study comparing the outcomes of 273 patients treated for ankle arthritis with either arthrodesis or TAR. Patients had the option to choose their procedure (103 arthrodesis versus 170 TAR). TAR breakdown was 58 Agility with 9 INBONE and 103 Salto Talaris. Patients completed pain score, Musculoskeletal Function Assessment (MFA) and a Short Form-36 (SF-36) survey at baseline, six, 12, 24 and 36-month follow-up visits.
Results: There was significant mean improvement in most outcomes after surgery regardless of procedure with the greatest patient improvement occurring in the first six months of follow-up. It was noted the change between baseline and six months was greater than the change between six months and 36 months. Average improvement over the three-year follow-up period was significantly better in TAR group than arthrodesis for MFA and SF-36 scores. Better outcomes were more evident for TAR when only comparing those with newer generation implants to the arthrodesis. Younger patients and those with a lower BMI had greater overall postoperative improvements.
Conclusions: The study showed both TAR and ankle arthrodesis are effective treatments for end-stage arthritis with each having statistically significant improvement at three years after treatment. It should be noted that with an experienced surgeon, the TAR had greater MFA and SF-36 scores at three years. The newer implants also showed better results, potentially indicating future studies on TAR may yield clearer overall results in favor of the implant. All of this points to the growing trend of ankle replacement and continuing improvement in the newer devices. It is important that we, as podiatric physicians, are well versed in the literature and are able to offer our patients the best treatment options.