SLR - March 2016 - Milana Gordon

Title: Conversion of Tibiotalar Arthrodesis to Total Ankle Arthroplasty

Reference: Pellegrini MJ, Schiff AP, Adams SB, Queen RM, DeOrio JK, Nunley JA 2nd, Easley ME. Conversion of Tibiotalar Arthrodesis to Total Ankle Arthroplasty. J Bone Joint Surg 
Am, 2015 Dec 16;97 (24): 2004-2013.

Scientific Literature Review

Reviewed By: Milana Gordon, DPM
Residency Program: Beaumont Farmington Hills

Podiatric Relevance: As physicians we constantly strive to find the best solution for patients who are experiencing pain and disability/limitations. There have been studies which demonstrate that ankle arthrodesis is the best solution for end stage arthritis but the authors question whether converting a patient to a total ankle replacement would provide patient with pain relief and allow them to regain function/motion.

Methods: The study incorporated 23 ankle arthrodesis which were converted to total ankle arthroplasties. Data was collected prospectively. Exclusion criteria for the study included active infection, diabetic neuropathy, or medical comorbidities which stopped them from having surgery. Patients were given either an In-bone, STAR, or Salto-Talaris implant and 78 percent of the patients received concomitant procedures. There was a standardized surgical set of procedures regardless of the surgeon or implant type. Patient outcomes were assessed with the Visual Analog Score (VAS), the Short musculoskeletal function assessment (SMFA), and the Short Form-36 (SF-36). Range of motion was assessed as well as radiographic positioning.

Results: Of the 23 total ankle arthroplasties, 18 patients were used for assessment of functional outcomes. The mean VAS score improved from 65.7 +/- 21.8 preoperatively to 18.3 +/- 17.6 at the most recent follow up visit, with 5 patients being pain free. The SMFA bother and function indexes improved from 55 +/- 22.9 and 46.7 +/- 12.6 to 30.6 +/- 22.7 and 25.4 +/- 17.4 respectively. The SF-36 score improved from 37.7 +/- 19.3 to 56.4 +/-23.1. Three patients required revisional surgeries. Low-grade complications were seen in 10 ankles (malleolar fractures, wounds, and nerve impingement; all of which were managed successfully).

Conclusions: The authors concluded that the conversion of ankle arthrodesis to total ankle arthroplasty was an acceptable option for pain relief in patients. The conclusions that I reached were that there are other surgical options for pain after fusion. This will help me for future patients because I will be able to provide them with alternative treatments/surgeries. 

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