Contemporary Comparison of Short-Term Outcomes after Total Ankle Replacement and Ankle Arthrodesis

Category: Ankle, Ankle Arthritis Introduction/Purpose: During the last twenty years, studies comparing total ankle replacement (TAR) and ankle arthrodesis (AA) appear to demonstrate lower complication rates with TAR than with AA. However, advances in implant technology and surgical techniques have dramatically reduced complication rates. As a result, studies comparing TAR and AA require more patients to detect differences in rare events. Despite this, few epidemiologic studies have been performed examining short-term outcomes after TAR and AA using a contemporary patient population. The purpose of the current study was to compare perioperative outcomes after TAR and AA using patient data from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database between 2012 and 2017. Methods: We reviewed patient data from ACS-NSQIP database collected between 2012 and 2017 using Current Procedural Terminology (CPT) codes 27700 (TAR), 27702 (TAR), 29899 (AA) and 27870 (AA). Patients were then excluded if they were treated for fractures, infections, non-foot or ankle-related conditions or had revision procedures. Patients were also excluded if they were older than 90 years as ACS-NSQIP does not report age above 90 years. The study population included those treated in inpatient and outpatient settings. The main outcomes of interest were readmission and reoperation related to initial surgery, surgical site complications and hospital length of stay (LOS). Predictors of adverse outcomes were evaluated through multivariate regression of patient demographics, comorbidities and treatment characteristics. Results: Out of 1214 patients included in the study, 187 (15.4%) patients were treated with AA, and 1027 (84.6%) underwent TAR. Patients with AA were younger, had higher body-mass index, higher white blood cell count, more often had diabetes mellitus (DM) treated with insulin, received more dialysis treatment, had higher anesthesia risk classification and were treated in the outpatient setting more often than patients with TAR. Among outcomes, AA patients had longer hospital LOS, more deep surgical site infections and more reoperations than TAR patients. Post-operative readmissions were not significant but were higher in AA patients (2.7% vs. 0.9%, p=0.101). Combining these adverse outcomes, multivariate regression revealed that higher anesthesia risk category (p=0.0007), DM (p=0.029) and AA (p=0.049) had positive correlations with adverse outcomes. Conclusion: Ankle arthrodesis appears to be independently associated with perioperative complications compared to TAR, consistent with previous reports. Although complications were rare, patients with DM and higher anesthesia risk seem to be important factors to consider. Interestingly, patients with DM had fewer adverse outcomes with TAR than AA (3.8% vs. 7.4%). The difference was even greater in DM patients treated with insulin (4.3% vs. 13.3%) although only 38 patients had DM controlled with insulin in the cohort. Further studies are needed to identify patient populations at risk of complications, specifically those with DM.

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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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Trends in Complication Rates Following Ankle Arthrodesis and Total Ankle Replacement

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.15.01341 ◽

2016 ◽

Vol 98 (17) ◽

pp. 1453-1458 ◽

Cited By ~ 37

Author(s):

Alexandra I. Stavrakis ◽

Nelson F. SooHoo

Keyword(s):

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Complication Rates ◽

Ankle Replacement

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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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Is End-Stage Ankle Arthrosis Best Managed with Total Ankle Replacement or Arthrodesis? A Systematic Review

Advances in Orthopedics ◽

10.1155/2014/986285 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 18

Author(s):

Robert W. Jordan ◽

Gurdip S. Chahal ◽

Anna Chapman

Keyword(s):

Systematic Review ◽

Functional Outcome ◽

Controlled Trial ◽

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Online Databases ◽

Ankle Replacement ◽

Comparative Group ◽

Randomised Controlled ◽

End Stage

Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA) has been the surgical intervention of choice but the emergence of total ankle replacement (TAR) has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes.Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must be skeletally mature and suffering from ankle arthrosis of any cause. The intervention had to be an uncemented TAR comprising two or three modular components. The comparative group could include any type of ankle arthrodesis, either open or arthroscopic, using any implant for fixation. The study must have reported at least one functional outcome measure.Results. Of the four studies included, two reported some significant improvement in functional outcome in favour of TAR. The complication rate was higher in the TAR group. However, the quality of studies reviewed was poor and the methodological weaknesses limited any definitive conclusions being drawn.Conclusion. The available literature is insufficient to conclude which treatment is superior. Further research is indicated and should be in the form of an adequately powered randomised controlled trial.

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Intermediate-Term Results of Total Ankle Replacement and Ankle Arthrodesis

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.l.01597 ◽

2014 ◽

Vol 96 (2) ◽

pp. 135-142 ◽

Cited By ~ 148

Author(s):

Timothy R Daniels ◽

Alastair SE Younger ◽

Murray Penner ◽

Kevin Wing ◽

Peter J Dryden ◽

...

Keyword(s):

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Ankle Replacement

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Total ankle replacement and contralateral ankle arthrodesis in 16 patients from the Swedish Ankle Registry: Self-reported function and satisfaction

Foot and Ankle Surgery ◽

10.1016/j.fas.2015.04.007 ◽

2016 ◽

Vol 22 (1) ◽

pp. 32-34 ◽

Cited By ~ 8

Author(s):

Anders Henricson ◽

Martin Fredriksson ◽

Åke Carlsson

Keyword(s):

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Ankle Replacement

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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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Comparing Sports Activity Following Total Ankle Replacement Versus Ankle Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000338 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003 ◽

Cited By ~ 1

Author(s):

Seth Richman ◽

Tyler Rutherford ◽

Timothy Rearick ◽

John T. Campbell ◽

Rebecca Cerrato ◽

...

Keyword(s):

Decision Making ◽

The United States ◽

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Activity Level ◽

Activity Levels ◽

Sports Activity ◽

Ankle Replacement ◽

Foot Function

Category: Ankle, Ankle Arthritis, Sports Introduction/Purpose: Total ankle replacement (TAR) and ankle arthrodesis (AA) are two common surgical treatment modalities for end stage tibiotalar arthritis. A key deciding point between the two is anticipated functional outcome postoperatively, especially in regards to sports related activities. However, there is a paucity of data available to help advise patients in their decision making. While TAR provides a theoretical benefit of improved functionality, the outcomes of several European studies have shown mixed results. These studies are limited by small sample size, obsolete TAR implants not used in the United States, and nonspecific outcome measures. The purpose of this study was to compare postoperative sports activity levels following modern TAR and AA in a U.S. population, which may benefit surgical decision making and guide patient expectations. Methods: We conducted a retrospective comparative study that consisted of patients who underwent a TAR (N=62) or AA (N=51) between 2009-2015. The mean age of the arthrodesis group was 57.7 years ± 12.12 (28.84-85.26). There were 27 male participants and 24 female participants. The TAR group had 31 male and 31 female participants with a mean age of 64.9 years ± 8.57 (45-79.6). Exclusion criteria included paralysis, rheumatoid arthritis, revision surgery, incomplete pre- and post-operative scores, and follow up less than 2 years. General health and foot-ankle function were assessed using the SF-12 Health Survey and the revised Foot Function Index (FFI-R) preoperatively and at final follow-up. In addition, activity levels were assessed using a Return to Activities Following Surgery questionnaire that was administered at final follow up. This form included a Visual Analog Scale for Pain, satisfaction questions, and a list of 25 activities. Patients were asked to record their current level of activity, ability to participate pre- and post-surgery, and whether their desired level was met. All three measurements tools were compared between both treatment groups. Results: The SF-12 physical score both groups significantly increased postoperatively from 33.18 ± 10.37 to 43 ± 10.32 for AA’s and from 32.88 ± 9.44 to 45.81 ± 12.94 (p < 0.001) for TAR’s. The FFI scores showed a significant increase in both groups (p < 0.001). In the AA group, 88% of patients returned to work and would repeat the surgery, compared to 92% of patients in the TAR group. In terms of satisfaction and pain, the TAR group was more satisfied (1.78 vs. 1.44) and had less postoperative pain (1.32 vs. 2.56 p < 0.05). The AA group reported a significant increase in six activities including: golf (p < 0.05), weight lifting, and walking (p<0.001), while the TAR group reported significant increase in 15 activities, including hiking, tennis, and yoga (p<0.001). Conclusion: Our study revealed a significant increase in general physical function, foot function, and activity level in both groups. The TAR group was able to perform a wider range of activity and sports compared to the AA group. Overall, TAR patients were significantly more satisfied with their procedure compared to AA patients.

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