scholarly journals An Evaluation of Readability of Information on the Internet Regarding Total Ankle Replacement

2021 ◽  
Author(s):  
andrea mc carthy ◽  
Robert Flavin
Keyword(s):  
Health Literacy ◽  
Grade Level ◽  
Total Ankle Replacement ◽  
The Internet ◽  
Ankle Arthroplasty ◽  
Reading Grade Level ◽  
Ankle Replacement ◽  
Significant Difference ◽  
The Mean ◽  
Post Hoc

Abstract Background:Health literacy is defined as the ability to understand basic health information with such competence as to be able to use this information to enhance health. Lower health literacy is associated with increased post-operative complications, reduced satisfaction and compliance. To ensure accessibility and comprehension by the general public, many international health organisations suggest that health literature has a reading grade level equivalent to the American sixth grade. However, previous studies show that this rarely occurs.Total ankle replacement (TAR) technology has rapidly progressed with new prosthesis showing increasingly improving outcomes. However, TAR remains a complex procedure which may be challenging to explain to the patient. Thus, many patients will turn to the internet for more information and as a ‘quasi-second opinion’. If the health education materials provided on the internet is not accessible to patients, it can leave them overwhelmed and confused. The aim of the study is to evaluate the readability of information on the internet with regards to Total Ankle ReplacementMethods: 110 websites from the two main search engines (Google and Bing) were assessed using the terms ‘total ankle replacement’ and ‘total ankle arthroplasty’. Once duplicates had been removed and exclusion criteria were applied, 36 unique websites were categorised and underwent analysis using readability software (WEB FX readability tool). The websites were assessed for readability using the Fleisch Reading Ease Score (FRES) and the Reading Grade Level (RGL). A score of greater than 65 for FRES and an RGL of six or less were considered acceptable. Differential and Inferential statistical analysis was performed using SPSS.Results:The mean FRES score was 54.95 (SD: ± 13.2); this was significantly below the recognised acceptable standard score of 65 (P<.0001). An ANOVA conducted showed significant difference between FRES scores based on categories (P=.041) with post-hoc testing showing that the difference between commercial and non-physician scores was the most significant (P=.016; CI:3.84-61.66).The mean RGL was 8.31 (SD: ± 1.95). One-way t-tests showed that these scores were significantly higher than the acceptable standard (P<.0001; CI: 1.64-2.97). ANOVA testing showed a significant difference based on category (P=.028) with post hoc testing showing significant difference between non physician and commercial scores (P=.012, CI: 0.71-9.33).Conclusion:The majority of the websites pertaining to total ankle replacement are significantly beyond the comprehension levels of the general public. This will affect the patient’s ability to discern the complexities and potential complications of total ankle arthroplasty, with serious ramifications for consent as well as post-operative rehabilitation and compliance.Level of Evidence: not applicable

scholarly journals Restoration of Talar Height using a Modular Revision Prosthesis after Failed Total Ankle Arthroplasty

2019 ◽  
Vol 4 (2) ◽  
pp. 2473011419S0000
Author(s):  
Brian Steginsky ◽  
Steven L. Haddad
Keyword(s):  
Postoperative Complications ◽  
Bone Loss ◽  
Ankle Arthrodesis ◽  
Cement Augmentation ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
The Mean

Category: Ankle Introduction/Purpose: Talar component subsidence is the most common indication for revision total ankle replacement. The management of talar bone loss and alteration in the ankle joint center of rotation is challenging following component subsidence. Unfortunately, ankle arthrodesis as a salvage procedure for failed ankle arthroplasty has been associated with high rates of nonunion and collapse. Equally unfortunate, there is paucity in the literature on revision total ankle arthroplasty. The purpose of this study was to report the early outcomes of revision total ankle replacement using a modular prosthesis and metal/cement augmentation to reconstitute talar height following catastrophic failure of the index total ankle arthroplasty. Methods: Retrospective review was performed on sixteen patients who underwent revision total ankle replacement for failed arthroplasty associated with talar component subsidence and subsequent talar bone loss. All patients underwent revision arthroplasty using a revision modular ankle prosthesis and had a minimum of one-year follow-up. Demographic data, postoperative complications, original prosthesis, and concomitant procedures were recorded. Radiographic measurements were performed at three time-points (preoperative, immediately after surgery, and at most recent follow-up) to evaluate alignment of the prosthesis, talar height, and ankle range of motion. Implant survivorship was determined. Failure was defined as >2 mm of talar subsidence, conversion to ankle arthrodesis or below the knee amputation, and/or revision of the prosthesis. Ankle Osteoarthritis Score (AOS), Foot Function Index (FFI), and visual analog score (VAS) were collected at the most recent postoperative visit. Results: Patient follow-up ranged from 12.1 –20.6 months, with a mean follow-up of 15.0 months. The mean preoperative and immediate postoperative talar height was 28.7 mm and 33.4 mm, respectively. There was a significant improvement in talar height of 4.7 mm after revision total ankle replacement (P<0.001). Talar height was maintained at most recent follow-up. The mean preoperative and postoperative radiographic arc of motion was 19.5° and 24.0°, respectively. Two patients, with a mean BMI of 43.5, developed >2 mm of talar subsidence (one patient required revision surgery). The mean postoperative AOS and FFI was 25.0 and 28.8, respectively. The majority of patients (84%) were satisfied with their outcome, and all patients would choose to undergo the same procedure again (vs. arthrodesis or amputation). Conclusion: Revision ankle replacement using a modular prosthesis with metal/cement augmentation allows restoration of talar height. Though we recognize this data constitutes a very early follow up, this cohort has utilized the revision ankle implant with significant repetitive load after which older generation implants underwent secondary subsidence due to poor talar bone stock. Early outcomes demonstrate a predictable method to salvage catastrophic prosthesis failure associated with severe talar subsidence and deformity. The risk of postoperative complications, although moderate, is an acceptable alternative to lower limb amputation/arthrodesis. Further follow-up is warranted to determine functional outcomes and longevity of revision implant systems.

scholarly journals SUFE and the internet: are healthcare information websites accessible to parents?

2020 ◽  
Vol 4 (1) ◽  
pp. e000782
Author(s):  
Andrea Mc Carthy ◽  
Colm Taylor
Keyword(s):  
Grade Level ◽  
Surgical Intervention ◽  
Sixth Grade ◽  
The Internet ◽  
Flesch Reading Ease ◽  
Reading Grade Level ◽  
Significant Difference ◽  
Ease Score ◽  
Slipped Upper Femoral Epiphysis ◽  
Translation Services

BackgroundSlipped upper femoral epiphysis is an adolescent hip disorder requiring rapid surgical intervention. Faced with the prospect of their child undergoing surgery, many fearful parents will turn to the internet to provide information and reassurance. Previous studies have shown the orthopaedic information can be difficult to comprehend.ObjectiveAssess the readability of healthcare websites regarding slipped upper femoral epiphysis.MethodsThe term Slipped Upper Femoral Epiphysis was searched in Google, Bing and Yahoo. The websites were evaluated using readability software with seven specialised readability tests including the Flesch-Kincaid Reading Grade Level, the Flesch Reading Ease Score, the Simple Measure of Gobbledygook, Coleman-Liau Index, Automated Readability Index and the Gunning Fog Index. The reading grade level (RGL) was also calculated.A Flesich Read Ease Score (FRES) score above 65 and an RGL of sixth grade and under was considered acceptable. Websites were also assessed for translation services.Results21 unique websites were assessed. The average FRES was 52.5±15.4. Only 3 websites scored 65 or higher (14%). There was a statistically significant difference between website scores based on affiliation, with physician websites having the overall highest mean(p=0.004).The average RGL was 8.67±1.8. Only two websites met the accepted RGL criteria (9.5%) while five websites were marked as extremely difficult to understand (23.8%). Only five websites offered translations (23.8%). There was no statistically significant difference in readability scores between websites which offered translation and those which did not.One-sample t-tests showed that both the RGL (p<0.001; CI 1.83 to 3.49) and the FRES (p<0.001, CI −19.4 to −5.4) scores were significantly different from the accepted standard.ConclusionMost websites reviewed were above the recommended RGL, making content inaccessible. Improving readability and translation services would enhance the internet’s usability as a healthcare tool for parents.

scholarly journals Restoration of Talar Height using a Modular Revision Prosthesis after Failed Total Ankle Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0011
Author(s):  
Brian Steginsky ◽  
Steven Haddad
Keyword(s):  
Postoperative Complications ◽  
Bone Loss ◽  
Cement Augmentation ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Modular Prosthesis ◽  
Ankle Replacement ◽  
The Mean

Category: Ankle Arthritis Introduction/Purpose: Talar component subsidence is the most common indication for revision total ankle replacement. The management of talar bone loss and alteration in the ankle joint center of rotation is challenging following component subsidence. Unfortunately, ankle arthrodesis as a salvage procedure for failed ankle arthroplasty has been associated with high rates of nonunion and collapse. Equally unfortunate, there is paucity in the literature on revision total ankle arthroplasty. The purpose of this study was to report the early outcomes of revision total ankle replacement using a modular prosthesis and metal/cement augmentation to reconstitute talar height following catastrophic failure of the index total ankle arthroplasty. Methods: A retrospective review was performed on sixteen patients who underwent revision total ankle replacement for failed arthroplasty associated with talar component subsidence and subsequent talar bone loss. Demographic data, postoperative complications, index implant, and concomitant procedures were recorded. Radiographic measurements were performed at three time-points (preoperative, immediately postoperative, and most recent follow-up) to evaluate alignment of the prosthesis, talar height restoration, and range of motion. Results: Patient follow-up ranged from 9.3 –19.1 months, with a mean follow-up period of 12.2 months. The maximum preoperative and postoperative talar coronal misalignment was 16.2° and 3.5°, respectively. The mean preoperative and immediate postoperative talar height was 28.7 mm and 33.3 mm, respectively. There was a significant improvement in talar height of 4.6 mm after revision total ankle replacement (P<0.001). There was no difference in talar height between the immediate postoperative visit and latest follow-up visit (33.2 mm). The mean preoperative and postoperative radiographic arc of motion was 19.5° and 24.0°, respectively. Ten patients (62.5%) did not sustain complications post surgical. Three patients developed a superficial wound complication that healed without additional surgery. One patient required a transmetatarsal amputation. Other complications included neuritis and DVT. Conclusion: Revision ankle replacement using a modular prosthesis with metal/cement augmentation allows restoration of talar height. Though we recognize this data constitutes a very early follow up, this cohort has utilized the revision ankle implant with significant repetitive load after which older generation implants underwent secondary subsidence due to poor talar bone stock. Early outcomes demonstrate a predictable method to salvage catastrophic prosthesis failure associated with severe talar subsidence and deformity. The risk of postoperative complications, although moderate, is an acceptable alternative to lower limb amputation/arthrodesis. Further follow up is warranted to determine functional outcomes and longevity of revision implant systems.

1071 SUFE and the Internet: Are Healthcare Information Websites Accessible to Parents?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Mc Carthy ◽  
C Taylor
Keyword(s):  
Grade Level ◽  
Surgical Intervention ◽  
Sixth Grade ◽  
The Internet ◽  
Healthcare Information ◽  
Reading Grade Level ◽  
Significant Difference ◽  
Accepted Standard ◽  
Ease Score ◽  
Slipped Upper Femoral Epiphysis

Abstract Background Slipped upper femoral epiphysis(SUFE) is an adolescent hip disorder requiring rapid surgical intervention. Faced with the prospect of their child undergoing surgery, many fearful parents will turn to the internet to provide information and reassurance. Previous studies have shown the orthopaedic information can be difficult to comprehend. Objective Assess the readability of healthcare websites regarding SUFE. Method The term Slipped Upper Femoral Epiphysis was searched in Google, Bing and Yahoo and evaluated using readability software with seven specialised readability tests. A Flesich Read Ease Score (FRES) score above 65 and a Reading Grade Level (RGL) of sixth grade and under was considered acceptable. Results 21 unique websites were assessed. The average FRES was 52.5 +/- 15.4. Only 3 websites scored 65 or higher (14%). There was a statistically significant difference between website scores based on affiliation, with physician websites having the overall highest mean(P = 0.004). The average RGL was 8.67 +/- 1.8. Only two websites met the accepted RGL criteria (9.5%) while five websites were marked as extremely difficult to understand (23.8%). Only five websites offered translations (23.8%). There was no statistically significant difference in readability scores between websites which offered translation and those which did not. One-way t-tests showed that both the RGL (p &lt; 0.001; CI: 1.83-3.49) and the FRES (P &lt; 0.001, CI: -19.4 to -5.4) scores were significantly different from the accepted standard. Conclusions Most websites reviewed were deemed inaccessible. Improving readability would enhance the internet’s usability as a healthcare tool for parents.

scholarly journals Adverse Events in Total Ankle Arthroplasty, Analysis of the FDA Medical and User Facility Device Experience Database

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0028
Author(s):  
Karim Mahmoud ◽  
Sreenivasulu Metikala ◽  
Kathryn O’Connor ◽  
Daniel Farber
Keyword(s):  
Adverse Events ◽  
Aseptic Loosening ◽  
Mandatory Reporting ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Mode Of Failure ◽  
User Facility

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement has become a popular treatment option for end stage ankle arthritis. Most of the reports of adverse events following total ankle replacement have been from high volume institutions and are subject to either observational or selection bias as well as potential under-reporting as they do not include the experience of community and lower volume centers and surgeons. The FDA’s Medical and User Facility Device Experience (MAUDE) Database provides a more complete scope of adverse events due to the mandatory reporting requirements by the FDA of implant manufactures. We reviewed the database to identify the common modes of failure and complications of total ankle implants Methods: We retrospectively reviewed reports of the MAUDE database from November 2011 to September 2018 regarding all total ankle implants. Each device in the MAUDE database is classified with a 3-letter code, we identified the 2 codes assigned to total ankle arthroplasty devices, and manually searched the FDA’s published Device Classification list for adverse events. All events were reviewed and classified. Data related to patient age or sex, surgeon, medical center location are not available in the database Results: We identified 1000 adverse reports in the period between November 2011 and September 2018. After exclusion of duplicate reports for single events or reports irrelevant to total ankle arthroplasty, a total of 697 adverse event reports were noted. The most common mode of failure was aseptic loosening (21%), followed by infection (16%), alignment and mechanical issues (instability, malalignment, malposition, stiffness, impingement) (15%), implantation issues (pin, screw or drill breakage, alignment guide problems) (9%), polyethylene related problems (wear, displaced or fractured implants) (7%), bony and soft tissue overgrowth (6%), and peri-prosthetic fractures (5%). Conclusion: Our analysis reveals that the most reported mode of failure was aseptic loosening followed by infection. However, it is notable that there are a significant number of issues with implant alignment and mechanics, complications during implantation and polyethylene component failure that are under-reported in the literature. Knowledge of these adverse events may help surgeons avoid similar complications as well as lead to improvement in component implantation and design

Revision Rates After Total Ankle Replacement: A Comparison of Clinical Studies and Arthroplasty Registers

2021 ◽  
pp. 107110072110538
Author(s):  
Georg Hauer ◽  
Reinhard Hofer ◽  
Markus Kessler ◽  
Jan Lewis ◽  
Lukas Leitner ◽  
...  
Keyword(s):  
Clinical Studies ◽  
Revision Rate ◽  
Mobile Bearing ◽  
Total Ankle Replacement ◽  
Second Step ◽  
Fixed Bearing ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Significant Difference

Background: The aim of this study was to assess the outcome of total ankle replacement (TAR) regarding revision rates by comparing clinical studies of the last decade to data displayed in arthroplasty registers. The secondary aim was to evaluate whether dependent clinical studies show a superior outcome to independent publications. Additionally, revision rates of mobile bearing implants (MB-TARs) were compared to those of fixed bearing implants (FB-TARs). Methods: Clinical studies on TARs between 2010 and 2020 were systematically reviewed, with the endpoint being a revision for any reason. The parameter “revision rate per 100 observed component years (CYs)” was calculated for each publication. The pooled revision rate for clinical studies was compared to the data reported in arthroplasty registers. In a second step, revision rates were subdivided and analyzed for independent and dependent publications and for FB-TARs and MB-TARs. Results: A total of 43 publications met the inclusion criteria comprising 5806 TARs. A revision rate of 1.8 per 100 observed CYs was calculated, corresponding to a 7-year revision rate of 12.6%. The 3 arthroplasty registers included showed revision rates ranging from 8.2% to 12.3% after 7 years. No significant difference between dependent and independent publications nor between FB-TARs and MB-TARs was detected. Conclusion: Revision rates of clinical studies and arthroplasty registers are comparable. Surgeons can compare their own revision rates with those from this study. Dependent studies do not seem to be biased, and no superiority for one bearing type can be described. Level of Evidence: Level III, systematic review of level III studies

scholarly journals Prospective Randomized Trial Comparing Mobile-bearing and Fixed-bearing Total Ankle Replacement

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0009
Author(s):  
James Nunley ◽  
Samuel Adams ◽  
James DeOrio ◽  
Mark Easley
Keyword(s):  
Clinical Outcomes ◽  
Mobile Bearing ◽  
Cyst Formation ◽  
Total Ankle Replacement ◽  
Fixed Bearing ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
Significant Difference ◽  
End Stage

Category: Ankle Arthritis Introduction/Purpose: Outcomes of total ankle replacement for the treatment of end-stage ankle arthritis continue to improve. Debate continues whether a mobile-bearing total ankle replacement (MB-TAR) or a fixed-bearing total ankle replacement (FB-TAR) is superior, with successful outcomes reported longterm for MB-TAR and at intermediate-to-longterm follow-up for newer generation FB-TAR. Although comparisons between the two total ankle designs have been reported, to our knowledge, no investigation has compared the two designs with a high level of evidence. This prospective, randomized controlled trial conducted at a single institution compares patient satisfaction, functional outcomes and radiographic results of the mobile-bearing STAR and the fixed-bearing Salto-Talaris in the treatment of end-stage ankle arthritis. Methods: This investigation was approved by our institution’s IRB committee. Between November 2011 and November 2014, adult patients with end-stage ankle osteoarthritis failing nonoperative treatment were introduced to the study. With informed consent, 100 patients (31 male and 69 female, average age 65, range 35 to 85) were enrolled; demographic comparison between the two cohorts was similar. Exclusion criteria included inflammatory arthropathy, neuropathy, weight exceeding 250 pounds, radiographic coronal plane deformity greater than 15 degrees or extensive talar dome wear pattern (“flat top talus”). Prospective patient-reported outcomes, physical exam and standardized weightbearing ankle radiographs were obtained preoperatively, at 6 and 12 months postoperatively, and then at yearly intervals. Data collection included visual analog pain score (VAS), short form 36 (SF-36), foot and ankle disability index (FADI), short musculoskeletal functional assessment (SMFA) and AOFAS ankle-hindfoot score. Surgeries were performed by non-design team orthopaedic foot and ankle specialists with total ankle replacement expertise. Statistically analysis was performed by a qualified statistician. Results: At average follow-up of 4.5 years (range 2-6 years) complete clinical data and radiographs were available for 84 patients; 7 had incomplete data, one had died, 4 were withdrawn after enrolling but prior to surgery and 4 were lost to follow-up. In all outcome measures, the entire cohort demonstrated statistically significant improvements from preoperative evaluation to most recent follow-up. There was no statistically significant difference in improvement in clinical outcomes between the two groups. Radiographically, tibial lucency/cyst formation was 26.8% and 20.9% for MB-TAR and FB-TAR, respectively. Tibial settling/subsidence occurred in 7.3% of MB-TAR. Talar lucency/cyst formation occurred in 24.3% and 2.0% of MB-TAR and FB-TAR, respectively. Talar subsidence was observed in 21.9% and 2.0% of MB-TAR and FB-TAR, respectively. Re-operations were performed in 8 MB-TAR and 3 FB-TAR, with the majority of procedures being to relieve impingement or treat cysts and not to revise or remove metal implants. Conclusion: For the first time, with a high level of evidence, our study confirms that patient reported and clinical outcomes are favorable for both designs and that there is no significant difference in clinical improvement between the two implants. The incidence of lucency/cyst formation was similar for MB-TAR and FB-TAR for the tibial component, but the MB-TAR had greater talar lucency/cyst formation and tibial and talar subsidence. As has been suggested in previous studies, clinical outcomes do not correlate with radiographic findings. Re-operations were more common for MB-TAR and in the majority of cases were to relieve impingement or treat cysts rather than revise or remove metal implants.

Comparing the Lifestyle of Veteran and Non-Veteran Families

2021 ◽  
Author(s):  
Seyed Alireza Afshani ◽  
Seyed Mojtaba Hosseini-motlagh ◽  
Hamide Shiri-Mohammadabad
Keyword(s):  
Health Literacy ◽  
Employment Status ◽  
Survey Method ◽  
Statistical Population ◽  
Significant Difference ◽  
The Status ◽  
Lifestyle Questionnaire ◽  
Mashhad City ◽  
The Mean

Background: Considering the role of lifestyle in promoting, maintaining, continuity health and the importance of paying attention to the veterans and their families who have suffered a lot in order to sacrifice for the homeland, the present study intends to compare the lifestyle among veterans and non-veterans in Mashhad city. Methods: This study was conducted using a survey method. The statistical population included the veteran and non-veteran families of Mashhad. A total of 360 questionnaires were filled out in this city. The research instruments were Lifestyle Questionnaire (LSQ) and All Aspects of Health Literacy Scale. The data were analyzed by SPSS v.24. Results: There is not a significant difference between the mean scores of lifestyle in the two groups of veteran and non-veteran in Mashhad (p > 0.05). The comparison of mean lifestyle scores also showed that there was no significant difference between the lifestyle scores of men and women in the non-veteran group and the mean scores of the single and married lifestyle in the veteran and non-veteran group (p > 0.05). There is a significant relationship between education level and health literacy of veteran and non-veteran families with their lifestyle, age, and employment status. They are also related to the lifestyle of their life because of the status they provide for the sacrifices. Conclusion: Comparison of the two groups in terms of lifestyle indicates that the veterans are in a less favorable position than non-veterans in terms of some aspects of lifestyle such as physical health, exercise and health, disease prevention and mental health.

Measuring Text Readability Using Reading Level

2019 ◽  
pp. 93-103
Author(s):  
James C. Brewer
Keyword(s):  
Grade Level ◽  
The United States ◽  
Reading Level ◽  
The Internet ◽  
Web Pages ◽  
Wide Audience ◽  
Reading Grade Level ◽  
Text Readability ◽  
Worldwide Phenomenon ◽  
The Military

Reading grade level calculations have been in use for over a century in the United States and have guided the selection of texts used in school programs. Government agencies at all levels, the military in its various branches, and editors of publications have found such formulas of use in setting policy or determining who can participate in programs. As readership is now a worldwide phenomenon with English as the primary language of the internet, reading grade level calculations can also be useful in creating web pages and assigning reading texts to large multi-user classes (MOOCs) run over the internet. In this regard, it is possible for faculty to be assured that the material is reachable to a wide audience by checking reading grade level and providing additional guidance for the more difficult items in the form of discussion or focused questions. Authors can use the formulas as a tool to check the quality of their own writing and improve sections which are unnecessarily complex.

Prospective Randomized Trial Comparing Mobile-Bearing and Fixed-Bearing Total Ankle Replacement

2019 ◽  
Vol 40 (11) ◽  
pp. 1239-1248 ◽  
Author(s):  
James A. Nunley ◽  
Samuel B. Adams ◽  
Mark E. Easley ◽  
James K. DeOrio
Keyword(s):  
Mobile Bearing ◽  
Cyst Formation ◽  
Total Ankle Replacement ◽  
Fixed Bearing ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Significant Difference ◽  
Patient Reported ◽  
End Stage

Background: Outcomes of total ankle replacement for the treatment of end-stage ankle arthritis continue to improve. Debate continues whether a mobile-bearing total ankle replacement (MB-TAR) or a fixed-bearing total ankle replacement (FB-TAR) is superior, with successful outcomes reported long term for MB-TAR and at intermediate- to long-term follow-up for newer generation FB-TAR. Although comparisons between the 2 total ankle designs have been reported, to our knowledge, no investigation has compared the 2 designs with a high level of evidence. This prospective, randomized controlled trial conducted at a single institution compares patient satisfaction, functional outcomes, and radiographic results of the mobile-bearing STAR and the fixed-bearing Salto-Talaris in the treatment of end-stage ankle arthritis. Methods: Between November 2011 and November 2014, adult patients with end-stage ankle osteoarthritis failing nonoperative treatment were introduced to the study. With informed consent, 100 patients (31 male and 69 female, average age 65 years, range 35-85 years) were enrolled; a demographic comparison between the 2 cohorts was similar. Exclusion criteria included inflammatory arthropathy, neuropathy, weight exceeding 250 pounds, radiographic coronal plane deformity greater than 15 degrees, or extensive talar dome wear pattern (“flat-top talus”). Prospective patient-reported outcomes, physical examination, and standardized weightbearing ankle radiographs were obtained preoperatively, at 6 and 12 months postoperatively, and then at yearly intervals. Data collection included visual analog pain score, Short Form 36, Foot and Ankle Disability Index, Short Musculoskeletal Functional Assessment, and American Orthopaedic Foot & Ankle Society ankle-hindfoot score. Surgeries were performed by a nondesign team of orthopedic foot and ankle specialists with total ankle replacement expertise. Statistical analysis was performed by a qualified statistician. At average follow-up of 4.5 years (range, 2-6 years) complete clinical data and radiographs were available for 84 patients; 7 had incomplete data, 1 had died, 4 were withdrawn after enrolling but prior to surgery, and 4 were lost to follow-up. Results: In all outcome measures, the entire cohort demonstrated statistically significant improvements from preoperative evaluation to most recent follow-up with no statistically significant difference between the 2 groups. Radiographically, tibial lucency/cyst formation was 26.8% and 20.9% for MB-TAR and FB-TAR, respectively. Tibial settling/subsidence occurred in 7.3% of MB-TAR. Talar lucency/cyst formation occurred in 24.3% and 2.0% of MB-TAR and FB-TAR, respectively. Talar subsidence was observed in 21.9% and 2.0% of MB-TAR and FH-TAR, respectively. Reoperations were performed in 8 MB-TARs and 3 FH-TARs, with the majority of procedures being to relieve impingement or treat cysts and not to revise or remove metal implants. Conclusion: With a high level of evidence, our study found that patient-reported and clinical outcomes were favorable for both designs and that there was no significant difference in clinical improvement between the 2 implants. The incidence of lucency/cyst formation was similar for MB-TAR and FH-TAR for the tibial component, but the MB-TAR had greater talar lucency/cyst formation and tibial and talar subsidence. As has been suggested in previous studies, clinical outcomes do not necessarily correlate with radiographic findings. Reoperations were more common for MB-TAR and, in most cases, were to relieve impingement or treat cysts rather than revise or remove metal implants. Level of Evidence: Level I, prospective randomized study.

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