Results of Total Ankle Replacement Compared with Fusion
Total ankle replacement (TAR) is still a fairly new treatment option for severe ankle pain and arthritis. Prior to ankle joint replacement, the standard treatment has been ankle fusion called arthrodesis.
How do the results of these two operations compare? The authors of this report reviewed 49 studies conducted over a 15-year period of time. Ten of the studies included patients receiving a TAR. The remaining 39 reports were on the results of ankle fusion.
As part of the review, the researchers also included abstracts from major orthopedic meetings held between 2003 and 2004. Pooling the data from all these studies allows comparisons when direct studies aren't available.
This is helpful when there aren't enough studies to answer the question of which operation gives the best result. It also avoids basing information on individual patient stories or personal experiences of the surgeon.
Results were measured by pain levels, joint motion, and ankle function. Implant survival was also recorded. Implant loosening or subsidence was counted as a failure for TAR patients. Subsidence refers to a sinking or shifting of the implant down into the bone. Nonunion or false joint called pseudoarthrosis was considered a failure for fusion.
Overall there was no significant difference in results between the two groups. About one-third of the patients in either group reported an excellent result. More patients in the TAR group had a poor result compared to the fusion group. The majority of patients in both groups rated their results as fair to good.
There were no studies that compared TAR to fusion directly. The pooled data from many studies is an acceptable way to compare treatment options. A direct study with matched patients is still needed. It would eliminate differences that occur from study to study.S. L. Haddad, MD, et al. Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis. In The Journal of Bone and Joint Surgery. September 2007. Vol. 89-A. No. 9. Pp. 1899-1905.