SLR - April 2018 - Kyung Seo

Comparison of Treatment Outcomes of Arthrodesis and Two Generations of Ankle Replacement Implants

Reference: Benich MR, Ledoux WR, Orendurff MS, Shofer JB, Hansen ST, Davitt J, Anderson JG, Bohay D, Coetzee JC, Maskill J, Brage M, Houghton M, Sangeorzan BJ. Comparison of Treatment Outcomes of Arthrodesis and Two Generations of Ankle Replacement Implants. The Journal of Bone and Joint Surgery. 2017; 99:1792–1800.

Scientific Literature Review

Reviewed By: Kyung Seo, DPM
Residency Program: Temple University Hospital, Philadelphia, PA

Podiatric Relevance: Ankle arthritis plays a significant role during ambulation and daily activity. End-stage ankle arthritis often requires surgery to provide better functional ability. There are two surgical approaches: Total Ankle Replacement (TAR) and ankle arthrodesis. There has been an increase in TAR over the last decade. The aim of this article is to compare treatment outcomes of ankle fusion and two TAR implants—one historical and one contemporary TAR implant.

Methods: This study enrolled a total of 273 patients between 2005 and 2011 after having either a TAR or ankle fusion. Each patient was evaluated on a pain scale (one to 10) and completed the MFA and SF-36 surveys. Surgeries were done by experienced surgeons to minimize complications. Both treatment cohorts followed a similar postoperative protocol.

Results: There were a total of 273 participants; 103 patients with ankle fusion and 170 patients with TAR. In the TAR group, 103 patients had Salto Talaris implants, 58 had the Agility implant, and nine patients had INBONE II. There were no significant differences between ankle arthrodesis and TAR with regard to baseline MFA or SF-36 scores. The greatest improvement occurred during the first six months of follow-up in both groups. However, the average improvement over the three-year follow-up period was significantly better in TAR patients than those with arthrodesis for both the MFA scores and SF-36 scores. Better outcomes were observed when comparing only patients who had received a newer-generation device with the arthrodesis group. It was also evident that young patients had greater postoperative improvement in MFA scores, and patients with lower BMI had better improvement postoperatively. 

Conclusion:
End-stage ankle arthritis can be surgically treated with two different procedures: TAR and ankle arthrodesis. Even though both can be highly effective, TAR resulted in more improvement in MFA and SF-36. This study also found better outcomes with newer-generation implants. Based on the results of this study, TAR provides superior outcomes compared to ankle arthrodesis at the three-year follow-up. 

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