The Journal of Bone and Joint Surgery (American). 2007;89:2143-2149.
doi:10.2106/JBJS.F.01611
© 2007 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activities for this article:
 Foot/Ankle Test 10: Winter 2008 (publication date February 15, 2008; expira...
CME 4: October, November, December 2007 (publication date January 4, 2008; ...
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by SooHoo, N. F.
Right arrow Articles by Ko, C. Y.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by SooHoo, N. F.
Right arrow Articles by Ko, C. Y.
Related Collections
Right arrow Foot/Ankle
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Comparison of Reoperation Rates Following Ankle Arthrodesis and Total Ankle Arthroplasty

Nelson F. SooHoo, MD1, David S. Zingmond, MD, PhD2 and Clifford Y. Ko, MD, MS, MSHS3

1 Department of Orthopaedic Surgery, University of California at Los Angeles, 10945 Le Conte Avenue, PVUB #3355, Los Angeles, CA 90095. E-mail address for N.F. SooHoo: nsoohoo{at}mednet.ucla.edu
2 Department of General Internal Medicine and Health Services Research, University of California at Los Angeles School of Medicine, 911 Broxton Plaza, Los Angeles, CA 90095
3 Department of General Surgery, University of California at Los Angeles School of Medicine, 10833 Le Conte Avenue, CHS 72–215, Los Angeles, CA 90095

Investigation performed at the Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: The role of ankle arthroplasty in the treatment of ankle arthritis is controversial. Ankle fusion is commonly performed, but there is ongoing concern about functional limitations and arthritis in the adjacent subtalar joint following ankle arthrodesis. The use of ankle arthroplasty as an alternative to ankle fusion is expanding, but reported results have been limited to those in case series. The purpose of this study was to compare the reoperation rates following ankle arthrodesis and ankle replacement on the basis of observational, population-based data from all inpatient admissions in California over a ten-year period. Our hypothesis was that patients treated with ankle replacement would have a lower risk of undergoing subtalar fusion but a higher overall risk of undergoing major revision surgery.

Methods: We used California's hospital discharge database to identify patients who had undergone ankle replacement or ankle arthrodesis as inpatients in the years 1995 through 2004. Short-term outcomes, including rates of major revision surgery, pulmonary embolism, amputation, and infection, were examined. Long-term outcomes that were analyzed included the rates of major revision surgery and subtalar joint fusion. Logistic and proportional hazard regression models were used to estimate the impact of the choice of ankle replacement or ankle fusion on the rates of adverse outcomes, with adjustment for patient factors including age and comorbidity.

Results: A total of 4705 ankle fusions and 480 ankle replacements were performed during the ten-year study period. Patients who had undergone ankle replacement had an increased risk of device-related infection and of having a major revision procedure. The rates of major revision surgery after ankle replacement were 9% at one year and 23% at five years compared with 5% and 11% following ankle arthrodesis. Patients treated with ankle arthrodesis had a higher rate of subtalar fusion at five years postoperatively (2.8%) than did those treated with ankle replacement (0.7%). Regression analysis confirmed a significant increase in the risk of major revision surgery (hazard ratio, 1.93 [95% confidence interval, 1.50 to 2.49]; p < 0.001) but a decreased risk of subtalar fusion (hazard ratio, 0.28 [95% confidence interval, 0.09 to 0.87]; p = 0.03) in patients treated with ankle replacement compared with those treated with ankle fusion.

Conclusions: This study confirms that, compared with ankle fusion, ankle replacement is associated with a higher risk of complications but also potential advantages in terms of a decreased risk of the patient requiring subtalar joint fusion. Additional controlled trials are needed to clarify the appropriate indications for ankle arthrodesis and ankle replacement.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
S. G. Kini
Conversion of Painful Ankle Arthrodesis to Total Ankle Arthroplasty
J. Bone Joint Surg. Am., August 1, 2009; 91(8): 2043 - 2044.
[Full Text] [PDF]

Home page
 JBJSHome page
R. C. Marx and M. S. Mizel
What's New in Foot and Ankle Surgery
J. Bone Joint Surg. Am., April 1, 2009; 91(4): 1023 - 1031.
[Full Text] [PDF]

Home page
 Foot Ankle SpecHome page
M. A. Reiley
Total Ankle Arthroplasty With Bone Defects
Foot & Ankle Specialist, February 1, 2009; 2(1): 32 - 34.
[Abstract] [PDF]