This Article Full Text Full Text (PDF) CME: Take the exams for this article: CME 3: July, August, September 2007 (publication date October 5, 2007; expi... Foot/Ankle Test 9: Fall 2007 (publication date November 15, 2007; expiratio... [Supplementary Material] Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Reprints and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Haddad, S.L. Articles by Nalysnyk, L. Search for Related Content PubMed PubMed Citation Articles by Haddad, S.L. Articles by Nalysnyk, L. Related Collections Foot/Ankle Social Bookmarking             What's this?

Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis

A Systematic Review of the Literature

¹ Illinois Bone and Joint Institute, Glenview Medical Arts Building, 2401 Ravine Way, 2nd Floor, Glenview, IL 60025. E-mail address: slhaddad{at}earthlink.net
² Orthopaedic Clinic, Riverside Campus, 1st Floor, R102, 2512 South 7th Street, Minneapolis, MN 55454
³ United BioSource Corporation, 101 Station Landing, Medford, MA 02155

Investigation performed at Illinois Bone and Joint Institute, Glenview, Illinois, and United BioSource Corporation, Medford, Massachusetts

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from DePuy Orthopaedics, a Johnson and Johnson Company. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (DePuy Orthopaedics). 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 video supplement related to the subject of this article has been developed by the American Academy of Orthopaedic Surgeons and JBJS and is available for viewing in the video library of the JBJS website, www.jbjs.org. To obtain a copy of the video, contact the AAOS at 800-626-6726 or go to their website, www.aaos.org and click on Educational Resources Catalog.

Methods: A comprehensive search of MEDLINE for all relevant articles published in English from January 1, 1990, to March 2005 was conducted. Additionally, relevant abstracts from the 2003 and 2004 annual proceedings of major orthopaedic meetings were eligible. Two reviewers evaluated each study to determine whether it was eligible for inclusion and collected the data of interest. Meta-analytic pooling of group results across studies was performed for the two procedures. The analysis of the outcomes focused on second-generation ankle implants.

Results: The systematic review identified forty-nine primary studies, ten of which evaluated total ankle arthroplasty in a total of 852 patients and thirty-nine of which evaluated ankle arthrodesis in a total of 1262 patients. The mean AOFAS (American Orthopaedic Foot and Ankle Society) Ankle-Hindfoot Scale score was 78.2 points (95% confidence interval, 71.9 to 84.5) for the patients treated with total ankle arthroplasty and 75.6 points (95% confidence interval, 71.6 to 79.6) for those treated with arthrodesis. Meta-analytic mean results showed 38% of the patients treated with total ankle arthroplasty had an excellent result, 30.5% had a good result, 5.5% had a fair result, and 24% had a poor result. In the arthrodesis group, the corresponding values were 31%, 37%, 13%, and 13%. The five-year implant survival rate was 78% (95% confidence interval, 69.0% to 87.6%) and the ten-year survival rate was 77% (95% confidence interval, 63.3% to 90.8%). The revision rate following total ankle arthroplasty was 7% (95% confidence interval, 3.5% to 10.9%) with the primary reason for the revisions being loosening and/or subsidence (28%). The revision rate following ankle arthrodesis was 9% (95% confidence interval, 5.5% to 11.6%), with the main reason for the revisions being nonunion (65%). One percent of the patients who had undergone total ankle arthroplasty required a below-the-knee amputation compared with 5% in the ankle arthrodesis group.

Conclusions: On the basis of these findings, the intermediate outcome of total ankle arthroplasty appears to be similar to that of ankle arthrodesis; however, data were sparse. Comparative studies are needed to strengthen this conclusion.

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

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				G. C. Berlet, L. A. DiDomenico, V. K. Panchbhavi, and J. K. Steck Roundtable Discussion: Ankle Arthritis Foot & Ankle Specialist, April 1, 2008; 1(2): 108 - 111. [PDF]

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2007 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.