Abstract: https://www.acpjournals.org/doi/10.7326/M22-2058
URL goes live when the embargo lifts
Newswise — A study of persons with end-stage ankle osteoarthritis found that both total ankle replacement (TAR) and ankle fusion (AF) improve patients quality of life and have similar clinical scores and risks after surgery. TAR was associated with a greater wound-healing complications and nerve injuries, while AF was associated with more blood clots and nonunion of the ankle bones. The findings are published in Annals of Internal Medicine.
Ankle osteoarthritis causes severe pain and disability. Persons with ankle osteoarthritis are primarily treated with nonoperative treatment, including weight loss, activity modification, support braces, and analgesia. However, surgical interventions may be used if non-surgical treatments are unsuccessful. The main surgical options are TAR and AF. TAR replaces the ankle joint and retains movement, while AF fuses the ankle bones together so there is no motion. It may be difficult for patients and clinicians to decide which intervention is more appropriate because of a lack of high-quality data to inform decision-making.
Researchers from University College London & Imperial College London conducted a randomized controlled trial of 303 persons with end-stage ankle osteoarthritis, aged 50 to 85 years, who the treating surgeon believed to be suitable for either ankle replacement or ankle fusion. After patients underwent operation, the authors calculated the clinical response by measuring the walking and standing domains of the Manchester–Oxford Foot Questionnaire at both preoperation and 52 weeks postoperation for each group. They found that both walking and standing domain scores improved by similar rates at 52 weeks for both groups. However, in a retrospective analysis they showed that the commonest ankle implant used in the UK, a fixed bearing, or two component ankle, in fact did show better outcomes than ankle fusion at 52 weeks. The investigators also report that each group experienced similar rates of adverse events, but TAR was associated with greater wound-healing complications and nerve injuries while AF was associated with more blood clots and nonunion of the ankle bones.
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