Outcomes of Total Ankle Replacement, Arthroscpoic Ankle Arthrodesis, and Open Ankle Arthrodesis for Isolated Non-deformed End-stage Ankle Arthritis

SLR - November 2019 - David H. Sved

Reference: Veljkovic AN, Daniels TR, Glazebrook MA, Dryden PJ, Penner MJ, Wing KJ, Younger ASE: Outcomes of Total Ankle Replacement, Arthroscpoic Ankle Arthrodesis, and Open Ankle Arthrodesis for Isolated Non-deformed End-stage Ankle Arthritis Journal of Bone and Joint Surgery 2019 September 4;101(17):1523-1529. doi: 10.2106/JBJS.18.01012

Scientific Literature Review

Reviewed By: David H. Sved, DPM
Residency Program: Ascension Wisconsin – Milwaukee, WI

Podiatric Relevance: End stage ankle arthritis is a debilitating deformity that is commonly encountered in the podiatric field. Ankle arthritis has similar effects on morbidity, pain, and loss of function as hip joint arthritis. This deformity can greatly hinder patients’ quality of life. There are a wide variety of treatment options whose effectiveness is commonly debated. This article aims to compare three major treatment options for end stage ankle arthritis. If evidence can be shown that a treatment option is superior for the management of ankle arthritis then a gold standard treatment algorithm could be created.

Methods: Patients that underwent Total Ankle Replacement (TAR), Arthroscopic Ankle Arthrodesis (AAA), or Open Ankle Arthrodesis (OAA) from 2002 to 2012 with a two-year follow up were retrospectively identified. This included 238 ankles in 229 patients (88 TAR, 50 AAA, and 100 OAA). All patients had symptomatic end stage ankle arthritis without intra-articular or extra-articular deformity or surrounding joint arthritis. Total Ankle Replacement was done using the HINTEGRA prosthesis.

Results: The authors of this paper found that preoperative AOS scores for pain, disability and total scores were similar for all patients. After surgery both TAR and AAA patients found a significantly larger increase in their AOS scores (34.4 +/- 22.26 and 38.3 +/- 23.6 respectively) compared to OAA. Improvements in AOS disability score was also larger for TAR and AAA compared to OAA however the TAR group had more reoperations than AAA and OAA.

Conclusions: The authors of this study found that AAA and OAA resulted in comparable clinical outcomes to TAR patients with end-stage ankle arthritis uncomplicated by intra or extra articular deformity. They found that component revision in TAR patients was similar to revisions of AAA and OAA, however TAR patients underwent a greater number of additional procedures and patients should be counseled on this issue. Overall, they found that AAA and TAR were not significantly different surgical options for short term outcomes.