Document Type : SYSTEMATIC REVIEW
Authors
1
University of Oxford NHS Foundation Trust. Nuffield Orthopaedic Centre, Windmill Rd, Oxford, OX3 7LD, UK
2
University of Oxford NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
3
Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Ave, Redhill RH1 5RH, UK
4
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom, OX3 7LD, UK
5
Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain
Abstract
Background: This study compares the outcomes of patients undergoing total ankle arthroplasty (TAA) and tibiotalar
fusion (ankle arthrodesis) in patients with end-stage osteoarthritis. The primary outcome assessed was Patient
Reported Outcome Measures (PROMS); secondary outcomes included the incidence of revision, re-operation, and
complications.
Methods: A systematic review of studies examining the outcomes of patients undergoing TAA and/or tibiotalar fusion
from 2006 to 2020 was conducted. Individual cohort studies and randomized control trials were included. Outcomes
were assessed at two and five years.
Results: 21 studies were included: 16 arthroplasty (2,016 patients) and 5 arthrodesis (256 patients) studies. No
significant difference in PROMS was evident two years post-surgery – American Orthopaedic Foot and Ankle Society
(AOFAS) scores were 78.8 (95% CI-confidence interval: 76.6-80.8; n=1548) and 80.8 (95% CI: 80.1-81.5; n=206
patients) for the arthroplasty and arthrodesis groups respectively. Two years post-surgery the revision rates for the
arthroplasty and arthrodesis groups were similar – 3.5% (n=9) and 3.7% (n=61) respectively (OR-odds ratio: 1.05; 95%
CI: 0.51-2.13); however, the re-operation rate was 2.5 times higher for the arthroplasty group (12.2%) in comparison to
the arthrodesis group (5.1%) (OR: 2.57; 95% CI: 1.43-4.62). Documented complications in the arthroplasty group were
half those documented in the arthrodesis group two years post-surgery (OR: 0.53; 95% CI: 0.37-0.77). No arthrodesis
studies were found which contained mean 5-year follow-up data within the study period.
Conclusion: Despite recent developments in TAA design, we found no clear evidence as to their superiority over ankle
arthrodesis when considering patient outcomes two years postoperatively. However, this conclusion could be debatable
in some types of patients such as diabetic patients, posttraumatic patients and patients with stiff hindfoot and midfoot.
Level of Evidence: III
Keywords
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