1. Total Ankle Arthroplasty Versus Ankle Arthrodesis: a Meta-Analysis
Jordan Crafton, BS1, David Shofler, DPM, MSHS2
1 Second-year student, College of Podiatric Medicine, Western University of Health Sciences, 2 Assistant professor, College of Podiatric Medicine, Western University of Health Sciences
RESULTS: Side by Side Comparison with Previous Study
INTRODUCTION
DEMOGRAPHICS
RESULTS: Side by Side Comparison with Previous Study
The choice of total ankle replacement or ankle fusion has been a debated topic for end-stage arthritis of the ankle joint. For many years, ankle arthrodesis was the gold standard for patients with end-stage ankle arthritis. A systematic review and meta-analysis led by Haddad et al assessed studies at a chronological end-point of March Nearly 10 years have passed since then. The goal of this meta-analysis was to serve as a comparative update, assessing the literature from April 2005-July 2014.
Current Study
Haddad et al. study
Difference
Total Ankle Arthroplasty
Ankle Arthrodesis
AOFAS
79.76
78.20
+1.56
72.61
75.60
-2.99
VAS
3.9
N/A
7.1
Excellent
14.29%
38%
-23.71%
22.02%
31.00%
-9.0%
Good
71.76%
30.50%
+41.26%
50.45%
37.00%
+13.45%
Fair
9.52%
5.50%
+4.02%
17.41%
13.00%
+4.41%
Poor
4.43%
24%
-19.57%
10.12%
-2.88%
Combined Excellent and Good
86.05%
68.50%
+17.55%
72.47%
68%
+4.47%
5-year survivorship
87.69%
78%
+9.69%
10-year survivorship
75.91%
77%
-1.09%
Revision
13.65% 7%
+6.65%
10.26% 9%
+1.26%
Amputation Rate
0.07% 1%
-.03%
1.13% 5%
-3.87%
Total Ankle Arthroplasty
Ankle Arthrodesis
Female:Male
2807:2755
460:778
Mean Age
60.9 years
50 years
Mean Duration of Follow up
51.3 months
54.2 months
RESULTS
Objective
This current meta-analysis reviews the outcomes of total ankle arthroplasty and ankle arthrodesis, for the chronological period of April 2005-July 2014.
Though the percentage of excellent subjective outcomes decreased compared to the earlier meta-analysis, the percentage of good subjective outcomes, as well as combined good/excellent subjective outcomes, substantially increased in the ankle arthroplasty group. The percentage of poor subjective outcomes decreased as well, though the implant revision rate slightly increased.
RESULTS: Side by Side Comparison of Procedures
Revisions and Amputations
Total Ankle Arthroplasty
Revsions/Ankles %
Total Ankle Arthroplasty Revision Rate
1236/9079
13.61%
Conversion to Arthrodesis Rate
168/9079
1.91%
Amputation rate
6/9079
0.07%
Most Common Causes of Revision
Aseptic loosening/subsidence/persistent pain/implant failure
368/1236
29.77%
Stiff ankle/impingement/bone fragments/pain/arthrofibrosis/bone overgrowth
105/1236
10.16%
Varus or valgus deformity/instability/malalignment/deformity in general
Infection
96/1236
9.30%
PE insert/bearing subluxation/implant failure
95/1236
9.20%
Conversion to Arthrodesis % of revisions
175/1236
16.94%
Amputation % of revisions
6/1236
3.43%
Ankle Arthrodesis
Total Revisions Ankle Arthrodesis
152/1599
10.26%
16/1599
1.13%
Non-union/unsatisfactory union/malalignment
49/152
32.24%
32/152
21.05%
Hardware malfunction
24/152
15.79%
Pain
16/152
10.53%
CONCLUSIONS
METHODS
In the past 10 years, patient satisfaction following ankle arthroplasty has improved. This trend may be explained by improvements in implant technology and physician training. As a caution, revision rates have slightly increased as well. Ankle arthrodesis outcomes have not significantly changed during this time period.
Two comprehensive literature searches of PubMed were conducted.  For one search, “ankle arthroplasty” was used as the search term; for the second search, the search term, “ankle arthrodesis” was used. Exclusion criteria were identical to those proposed by Haddad et al. While 317 articles were identified, 220 articles were excluded. This yielded 38 arthrodesis studies with 1508 ankles (1472 patients) and 52 arthroplasty studies with 7888 ankles (7642 patients).  
REFERENCES
1.Haddad S.L, Coetzee J.C, Estok R, Fahrbach K, Banel D, and L. Nalysnyk. Intermediate and long-term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis A Systematic Review of the Literature. J Bone Joint Surg Am. 2007;89:
2. Wood P.L.R, Sutton C., Mishra V., Suneja R. A randomised, controlled trial of two mobile bearing total ankle replacements. J Bone Joint Surg Br B:69-74.
3. Ferkel , R.D., Hewitt M. Long-Term Results of Arthroscopic Ankle Arthrodesis. Foot Ankle Int : 275.
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