SLR - May 2014 - Megan Johnson
Reference: Daniels TR, Alastair SE, Younger MB, Penner M, Wing K, Dryden P, Wong H, Galzebrook M. Intermediate-Term Results of Total Ankle Replacement and Ankle Arthrodesis: A COFAS Multicenter Study. J Bone Joint Surg Am, 96 (2): 135-142, 2014.Scientific Literature Review
Reviewed By: Megan Johnson, DPM
Residency Program: MedStar Washington Hospital Center
Podiatric Relevance: This study is relevant to the podiatric community because of the increasing popularity of the total ankle replacement (TAR) procedure. However, the literature has provided little data on the clinical outcomes. Some surgeons may be reluctant to pursue this treatment option due to the lack of evidence as to whether or not TAR is a long-term, viable treatment option for end-stage ankle arthritis. This article compares the outcomes of the total ankle replacement and ankle arthrodesis at an intermediate length of time.
Methods: Patients in the Canadian Orthopedic Foot and Ankle Society (COFAS) Prospective Ankle Reconstruction database were treated with either total ankle joint replacement or ankle arthrodesis. Six different orthopaedic surgeons performed the procedures. The ankle implants used included Agility, STAR, Mobility and Hintegra. The authors compared demographics, comorbidities, Ankle Osteoarthritis Scale (AOS) and SF-36 scores. Scores were compared at the preoperative time interval and at least four years postoperatively.
Results: There were 321 ankles (232 ankle replacements and 89 arthrodeses) reviewed at a mean follow-up of 5.5 years. Revision occurred in seven (7 percent) of the arthrodeses and forty-eight (17 percent) of the ankle replacements. The major complication rates were 7 percent for arthrodesis and 19 percent for ankle replacement. The mean AOS scores improved from 53.4 preoperatively to 33.6 postoperatively in the arthrodesis group and from 51.9 to 26.4 in those who underwent ankle replacement. Differences between the groups for SF-36 and AOS scores were minimal.
Conclusions: This study shows the clinical outcomes between the total ankle replacement and ankle arthrodesis groups were similar. However, there is a higher revision and major complication rate associated with total ankle replacement.