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

Abstract

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.

Hindfoot fusion in haemophilic arthropathy: 6‐year mean follow‐up of 41 procedures performed in 28 adult patients

“…The most recent systematic review by Jordan et al . does not show convincing differences in outcomes for ankle arthrodesis and TAR . The lack of evidence to support the use of TAR in haemophiliacs means that many opt for arthrodesis .…”

Hallux valgus, ankle osteoarthrosis and adult acquired flatfoot deformity: a review of three common foot and ankle pathologies and their treatments

“…7,8,12 Ankle arthrodesis has been demonstrated to result in significant pain alleviation and good functional results. 9,10,13,14 In recent years there has been a trend towards arthroscopic ankle arthrodesis because it has been shown to result in shorter hospital stay, lower initial complication rate and better early outcome. 15 Performing arthroscopic ankle arthrodesis in cases of severe deformity, however, may be challenging, or impossible.…”

“…In terms of function and pain alleviation, mid-term results after TAA are equivalent to those following ankle arthrodesis. 9,10,14 In terms of biomechanics, neither the arthrodesis nor the TAA is able to restore normal gait. Nevertheless, TAA is associated with a more physiological gait pattern than arthrodesis.…”

Total ankle joint replacement

“…A recent systematic review assessing ankle replacement and ankle fusion in patients with ankle arthrosis of any cause included four comparative studies (three retrospective studies and one prospective non-randomised trial) involving a total of 303 ankles 24. Two studies reported better improvements in functional outcomes with ankle replacement and the other two found no difference between the two procedures.…”