Comparison of Total Ankle Replacement and Ankle Arthrodesis During the Recovery Period

Category: Ankle, Ankle Arthritis Introduction/Purpose: Two reliable surgical alternatives exist for end-stage ankle arthritis, ankle arthrodesis and total ankle replacement. Several comparative studies have shown similar clinical results between the two procedures at intermediate-term follow-up (2 to 6 years). Despite this comparative literature, no studies have been dedicated to determining which of the two procedures allows better function and pain during the recovery period (the first 6 months following the procedure). This information is especially beneficial to patients for whom a more difficult and longer recovery is particularly adverse, such as elderly patients or patients with medical comorbidities. It is also unclear if pain or dysfunction during the recovery period correlates with intermediate-term complications such as nonunion or prosthetic loosening. Methods: This is a single site retrospective case-control study. Patient-Reported Outcomes Measurement Information System (PROMIS) scores have been completed by patients at the orthopedic foot and ankle clinic at each visit since October 2014. Patients who have undergone either a total ankle replacement or an ankle arthrodesis during that timeframe were evaluated to determine their level of pain, function, anxiety and depression at a given interval (from preoperative to 6 months) during their recovery. Data acquisition was via chart review. Exclusion criteria included Charcot neuroarthropathy and inadequate data. Results: 138 procedures (58 total ankle replacements, 80 ankle arthrodeses) were performed at our institution during the study period. Chart review of patients meeting inclusion criteria is currently being conducted to record PROMIS scores, adjuvant procedures, complications, return to work and post-operative protocol during the first 6 months following the procedure. Data analysis will be undertaken, to detect a minimally important difference between PROMIS scores, with a 95% confidence interval and power of 0.8, the minimal sample size was calculated to be 44 subjects in each group. For patients who developed a complication from surgery (non-union, implant loosening, infection, etc.), scores will be reviewed to determine if abnormal PROMIS scores early on in the recovery period correlate with future complications. Conclusion: Patient pain and function during the first 6 months following surgery is an important consideration for those contemplating both ankle arthrodesis and replacement as options. Data collected from this study to be completed by Spring 2017 will help to clarify if differences between the two procedures exist.

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Total Ankle Arthroplasty Survivorship, Complication, and Revision Rates in Patients Younger Than 55 Years

Foot & Ankle Specialist ◽

10.1177/1938640020980925 ◽

2021 ◽

pp. 193864002098092

Author(s):

Devon W. Consul ◽

Anson Chu ◽

Travis M. Langan ◽

Christopher F. Hyer ◽

Gregory Berlet

Keyword(s):

Case Series ◽

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Implant Survival ◽

Ankle Arthritis ◽

Single Institution ◽

Retrospective Case ◽

Ankle Replacement ◽

End Stage

Total ankle replacement has become a viable alternative to ankle arthrodesis in the surgical management of advanced ankle arthritis. Total ankle replacement has generally been reserved for patients who are older and for those who will have a lower demand on the replacement. The purpose of the current study is to review patient outcomes, complications, and implant survival in patients younger than 55 years who underwent total ankle replacement at a single institution. A single-center chart and radiographic review was performed of consecutive patients who underwent total ankle replacement for treatment of end-stage ankle arthritis. All surgeries were performed by 1 of 5 fellowship-trained foot and ankle surgeons at a single institution. A total of 51 patients met inclusion criteria with a mean follow-up of 31.2 months (SD = 16.2). Implant survival was 94%, There were 7 major complications (13%) requiring an unplanned return to the operating room and 8 minor complications (15%) that resolved with conservative care. The results of this study show that total ankle replacement is a viable treatment option for patients younger than 55 years. Levels of Evidence: A retrospective case series

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Nationwide Analysis of Total Ankle Replacement and Ankle Arthrodesis in Medicare Patients: Trends, Complications, and Cost

Foot & Ankle Specialist ◽

10.1177/1938640020950181 ◽

2020 ◽

pp. 193864002095018

Author(s):

William A. Tucker ◽

Brandon L. Barnds ◽

Brandon L. Morris ◽

Armin Tarakemeh ◽

Scott Mullen ◽

...

Keyword(s):

Surgical Intervention ◽

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Complication Rates ◽

Ankle Arthritis ◽

Ankle Replacement ◽

Procedure Cost ◽

Medicare Patients ◽

Retrospective Comparative Study ◽

End Stage

Background Surgical management of end-stage ankle arthritis consists of either ankle arthrodesis (AA) or total ankle replacement (TAR). The purpose of this study was to evaluate utilization trends in TAR and AA and compare cost and complications. Methods Medicare patients with the diagnosis of ankle arthritis were reviewed. Patients undergoing surgical intervention were split into AA and TAR groups, which were evaluated for trends as well as postoperative complications, revision rates, and procedure cost. Results A total of 673 789 patients were identified with ankle arthritis. A total of 19 120 patients underwent AA and 9059 underwent TAR. While rates of AA remained relatively constant, even decreasing, with 2080 performed in 2005 and 1823 performed in 2014, TAR rates nearly quadrupled. Average cost associated with TAR was $12559.12 compared with $6962.99 for AA ( P < .001). Overall complication rates were 24.9% in the AA group with a 16.5% revision rate compared with 15.1% and 11.0%, respectively, in the TAR group ( P < .001). Patients younger than 65 years had both higher complication and revision rates. Discussion TAR has become an increasingly popular option for the management of end-stage ankle arthritis. In our study, TAR demonstrated both lower revision and complication rates than AA. However, TAR represents a more expensive treatment option. Levels of Evidence: Level III: Retrospective comparative study

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Outcomes of Total Ankle Replacement, Arthroscopic Ankle Arthrodesis, and Open Ankle Arthrodesis for Isolated Non-Deformed End-Stage Ankle Arthritis

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.18.01012 ◽

2019 ◽

Vol 101 (17) ◽

pp. 1523-1529 ◽

Cited By ~ 8

Author(s):

Andrea N. Veljkovic ◽

Timothy R. Daniels ◽

Mark A. Glazebrook ◽

Peter J. Dryden ◽

Murray J. Penner ◽

...

Keyword(s):

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Ankle Arthritis ◽

Ankle Replacement ◽

End Stage

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Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty at 2-years Follow-up

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00059 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0005

Author(s):

Francesco Granata ◽

Camilla Maccario ◽

Luigi Manzi ◽

Eric Tan ◽

Federico Giuseppe Usuelli

Keyword(s):

Functional Limitation ◽

Total Ankle Replacement ◽

Total Ankle Arthroplasty ◽

Ankle Arthritis ◽

Hindfoot Alignment ◽

Ankle Arthroplasty ◽

Ankle Replacement ◽

Patient Reported ◽

American Orthopaedic

Category: Ankle Arthritis Introduction/Purpose: Ankle arthritis is a highly limiting pathology that causes pain and functional limitation with subsequent deterioration of quality of life. With recent advances in surgical instrumentation and techniques, prosthetic replacement of the ankle has proved to be a valid alternative to arthrodesis with comparable outcomes. The purpose of this study was to evaluate clinical and radiological findings in a transfibular total ankle replacement with two years follow-up. Methods: This prospective study included 59 patients who underwent transfibular total ankle arthroplasty from May 2013 to December 2015. The mean age was 51.6 ± 13.4 years. All patients were followed for at least 24 months postoperative with an average follow-up of 42.0 ± 23.5 months. Patients were assessed clinically and radiologically preoperatively and at 6, 12, and 24 months postoperatively. Results: At 24 months, patients demonstrated statistically significant improvement in the American Orthopaedic Foot and Ankle Society score from 33.6 to 88.1 (P<0.01), VAS scale from 79.3 to 14.0 (P<0.01) and SF-12 Physical and Mental Composite Scores from 29.9 and 44.6 to 74.4 and 95.3, respectively (P<0.01). Ankle dorsiflexion and plantarflexion improved from 5.5 and 8.8 degrees to 24.2 and 20.0 degrees, respectively (P<0.01). Radiographically, patients demonstrated neutral alignment of the ankle with a tibio-talar ratio of 34.9 ± 9.2 and hindfoot alignment view angle of 1.2 ± 7.0 degrees. No patient demonstrated any radiographic evidence of tibial or talar lucency at 24 months. Seven patients underwent reoperation for removal of symptomatic hardware; one patient developed a postoperative prosthetic infection requiring placement of an antibiotic spacer. Conclusion: This study demonstrates that transfibular total ankle replacement is a safe and effective option for the patients for ankle arthritis with improvements in patient-reported outcomes, range of motion, and radiological parameters. However, further studies are required to determine the mid- and long-term performance of these implants.

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Outcomes of Revision Total Ankle Replacement: A Minimum of 2 Year Follow-up

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00320 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0032

Author(s):

Andrea Pujol Nicolas ◽

Jayasree Ramas Ramaskandhan ◽

Triin Nurm ◽

Malik Siddique

Keyword(s):

Total Ankle Replacement ◽

Return To Sports ◽

Ankle Arthritis ◽

Ankle Replacement ◽

Patient Reported ◽

The Mean ◽

End Stage ◽

Average Domain

Category: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle replacement as a valid treatment for end stage ankle arthritis, is gaining popularity and every year there is an increasing number of procedures. With revision rates as high as 21% at 5 years and 43% at 10 years there is a need for understanding and reporting the outcome of revision ankle replacement. Our aim was to study the patient reported outcomes following revision TAR with a minimum of 2 year follow up. Methods: All patients that underwent a revision total ankle replacement between 2012 and 2016 were included in the study. All patients received a post-operative questionnaire comprising of MOX-FQ score, EQ-5D (UK) and Foot and Ankle outcomes scores (FAOS) and patients satisfaction questionnaire with a minimum of 2 years follow up. Results: 32 patients had a revision total ankle replacement between 2012 and 2016. 2 patients were deceased therefore 30 patients were included in the study. 5 patients declined participation for completing questionnaires. We received 21 (66%) completed questionnaires. The mean MOX-FQ average domain score for pain was 58.8, walking/standing 65.8 and social function was 48.2. The mean FAOS scores were 50.7 for pain, 50.6 for symptoms, 54.9 for ADL and 28.2 for quality of life. The mean overall health score today for EQ-5D was 67.8/100. 45% of patients were satisfied with the pain relief and return to sports and recreation obtained following the operation, 48% were satisfied with the improved in daily activities. 52% were overall satisfied with the results from surgery. Conclusion: Revision total ankle replacement gives overall satisfactory results demonstrated from patients reported outcomes at a minimum of 2 years following surgery.

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Sex Differences in End-Stage Ankle Arthritis and Following Total Ankle Replacement or Ankle Arthrodesis

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.21.00287 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Andrew Dodd ◽

Ellie Pinsker ◽

Alastair S.E. Younger ◽

Murray J. Penner ◽

Kevin J. Wing ◽

...

Keyword(s):

Sex Differences ◽

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Ankle Arthritis ◽

Ankle Replacement ◽

End Stage

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Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty

Foot & Ankle International ◽

10.1177/1071100718798851 ◽

2018 ◽

Vol 40 (1) ◽

pp. 24-33 ◽

Cited By ~ 11

Author(s):

Federico G. Usuelli ◽

Camilla Maccario ◽

Francesco Granata ◽

Cristian Indino ◽

Venus Vakhshori ◽

...

Keyword(s):

Short Form ◽

Case Series ◽

Total Ankle Replacement ◽

Total Ankle Arthroplasty ◽

Ankle Arthritis ◽

Plate Removal ◽

Ankle Arthroplasty ◽

Ankle Replacement ◽

Patient Reported

Background: Ankle arthritis is a highly limiting pathology that causes pain and functional limitation with subsequent deterioration of quality of life. With recent advances in surgical instrumentation and techniques, prosthetic replacement of the ankle has proven to be a valid alternative to arthrodesis with comparable outcomes. The purpose of this study was to evaluate clinical and radiological findings in a transfibular total ankle replacement with follow-up of at least 2 years. Methods: This prospective study included 89 patients who underwent transfibular total ankle arthroplasty from May 2013 to February 2016. The mean age was 53.2 ± 13.5 years. All patients were followed for at least 24 months postoperatively with an average follow-up of 42.0 ± 23.5 months. Patients were assessed clinically and radiographically preoperatively and at 6, 12, and 24 months postoperatively. Results: At 24 months postoperatively, patients demonstrated statistically significant improvement in the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score from 33.8 ± 14.3 to 88.5 ± 6.6 ( P < .001), visual analog scale (VAS) from 80.5 ± 17.0 to 14.1 ± 9.2 ( P < .001), and Short Form-12 Physical and Mental Composite Scores from 29.9 ± 6.7 and 43.3 ± 8.6 to 47.0 ± 7.6 and 53.3 ± 8.1, respectively ( P < .001). In addition, ankle dorsiflexion and plantarflexion improved from 6.2 ± 5.5 and 9.6 ± 5.8 degrees to 24.2 ± 7.9 and 18.1 ± 7.6 degrees, respectively ( P < .001). Radiographically, patients demonstrated maintained neutral alignment of the ankle at 24 months. No patient demonstrated any radiographic evidence of tibial or talar lucency at final follow-up. Seven patients underwent reoperation for removal of symptomatic hardware (6 fibular plates, 1 syndesmotic screw); 2 patients experienced delayed wound healing. The first one was treated with plate removal and flap coverage. The second one required fibular plate removal. One patient developed a postoperative prosthetic infection requiring operative debridement, removal of implants, and placement of an antibiotic spacer. Conclusion: This study found that transfibular total ankle replacement was a safe and effective option for patients with ankle arthritis resulting in improvements in patient-reported outcomes, range of motion, and radiographic parameters. However, further studies are required to determine the mid- and long-term performance of these implants. Level of Evidence: Level IV, case series.

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Step Activity After Surgical Treatment of Ankle Arthritis

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00075 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0007

Author(s):

William Ledoux ◽

John Anderson ◽

Donald Bohay ◽

J. Chris Coetzee ◽

James Davitt ◽

...

Keyword(s):

Surgical Treatment ◽

Activity Index ◽

Ankle Arthrodesis ◽

Ankle Arthritis ◽

Step Counts ◽

Sustained Activity ◽

Ankle Replacement ◽

Treatment Type ◽

Patient Reported

Category: Ankle Arthritis Introduction/Purpose: We used step counts as objective measures of activity as a compliment to patient self-reported outcomes in treatment of ankle arthritis to validate success or failure of treatment. Methods: 234 patients who were treated with ankle arthrodesis or ankle replacement wore step activity monitors before treatment and after treatment at 6 months, 12 months, 24 months and 36 months. Total steps taken as well as low, medium and high activity, sustained activity, and an activity index were measured in each group. In addition, step activity was compared with the subjects’ self-reported outcome using the MFA and SF-36. We measured change from baseline and compared treatment type. Linear mixed-effects regression analysis was used to test for improvement in step activity (the dependent variables) across follow-up (the fixed effect, modeled as 4 dummy variables representing differences from pre-op at 6, 12, 24 and 36 months), with fixed covariates age, sex, body mass index (BMI) and surgical treatment. Results: Both treatment groups improved significantly. Objective and PROM were not parallel. While PROM plateaued at 6 months, steps continued to increase at 36 months. Step counts increases did correlate with improving PROM however. Patients undergoing arthrodesis had slower improvement than arthroplasty patients with greater differences in the early stages of recovery (i.e., 6 and 12-month post-op) than at 36 months where improvements were similar across groups. (See table 2 for data). The trajectory of recovery was different but there were no significant differences in improvement by surgery procedure. Conclusion: Patients increase the number and the intensity of steps after treatment. Improvement after arthrodesis and ankle replacement follow different trajectories. For step totals, high intensity steps and the sustained activity metrics, arthroplasty patients showed more improvement than arthrodesis patients early in recovery. Step data are consistent with patient reported outcomes but do not parallel them. Unlike PROM which improve dramatically in the first six months then plateau, step activity demonstrated mild or no improvement at 6 months but later had improvement that increased gradually across follow-up out to three years. Objective outcome measures add value to measurement of treatment outcomes.

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Outcome after 52 Salto Ankle Prostheses Implanted by a Single Surgeon

Advances in Orthopedics ◽

10.1155/2018/2735634 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Frank W. M. Faber ◽

Monique J. L. Mastboom ◽

Sabine T. van Vliet-Koppert ◽

Ilse C. E. Bouman ◽

Paulien M. van Kampen

Keyword(s):

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Ankle Arthritis ◽

Hospital Data ◽

Gold Standard Method ◽

Satisfaction Rate ◽

Ankle Replacement ◽

High Satisfaction Rate ◽

Reliable Solution ◽

End Stage

While ankle arthrodesis was traditionally the gold standard method of treatment for disabling end-stage ankle arthritis, total ankle replacement (TAR) has been an acceptable alternative. The satisfaction rate of patients with TAR however differs. The purpose of our study is to investigate whether implant survival and results with special emphasis on the satisfaction rate of patients treated with a TAR implanted by a single surgeon were comparable to the literature. This was a retrospective cohort study in a teaching hospital. Data was collected from 52 patients who received a total ankle replacement (TAR) between 05/2002 and 06/2014. The mean follow-up time was 4.2 years (95% CI 3.3 – 5.0). Results showed a high satisfaction rate of 94% and 94% survival of the TAR after 5 years. We conclude that TAR with the Salto prosthesis is, in our hands, a reliable solution for end-stage ankle arthritis, with results comparable to the literature.

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Ankle Arthrodesis with Structural Grafts Can Work for the Salvage of Failed Total Ankle Replacement

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000187 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Adam Halverson ◽

Gregory Berlet

Keyword(s):

Femoral Head ◽

Limb Salvage ◽

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Limb Length ◽

Bone Block ◽

Structural Allograft ◽

Ankle Replacement ◽

Patient Reported

Category: Ankle, Ankle Arthritis Introduction/Purpose: Surgical treatment options after failed total ankle replacement (TAR) are limited to revision total ankle replacements, revision bone block interposition arthrodesis, or amputation. In patients where revision TAR is not an option and limb salvage is desired, conversion to an ankle arthrodesis can provide a stable, plantigrade foot. Revision arthrodesis is challenged by significant bone loss with removal of the TAR implant. The purpose of this study was to report midterm outcomes and radiographic results in a single surgeon’s group of patients who have undergone revision ankle arthrodesis with intramedullary nail fixation and structural allograft augmentation following failed TAR. Methods: Institutional review board approval was obtained for this study. A retrospective chart and radiographic review was performed. Patients with a minimum follow-up of 1 year who underwent failed TAR revision with structural femoral head allograft and intramedullary tibiotalocalcaneal (TTC) nail fixation were included. Patients with less than 1-year follow-up and alternative fixation or graft constructs were excluded from the study. Data were collected upon enrollment visit and again at midterm follow-up ranging from 3-7 years post-operatively. Foot Function Index (FFI), American Orthopaedic Foot & Ankle Society (AOFAS) outcomes scores and radiographs were obtained at each visit. Primary outcomes of interest were the rate of limb salvage and patient reported outcome scores. Secondary outcomes include limb length correction and the fate of the structural allograft. Results: Five patients were available for enrollment. Average age at surgery was 63.2 (range 56-69) years. Enrollment visits averaged 1.68 years post-operative (range 0.95 - 3.78). Midterm follow-up was at an average of 5.2 years (range 4.7-5.6). Upon enrollment average FFI was 34.82 (range 8.82-75.88) and at midterm follow-up was 20.42 (range 0-35.38). AOFAS scores upon enrollment averaged 66.6 (range 61-77) and at midterm follow-up averaged 70.33 (range 54-88). Radiographic results show union in 4 of 5 patients at enrollment and in 2 of 3 patients upon midterm follow-up. Average limb length discrepancy at enrollment was 1.4 cm (range 0.5 - 2.0) and 1.6 cm (range 0.2 – 2.4) at midterm follow-up. Conclusion: Conversion of failed TAR to TTC fusion with femoral head allograft is a salvage technique that can lead to a functional arthrodesis and limb salvage in a situation where options are challenging. Our results show continued improvement in patient reported outcomes scores moving from short-term to midterm follow-up with preservation of limb length and no trend towards structural allograft resorption.

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