Session XI - Reconstruction
Sun., 10/10/04 Reconstruction, Paper #69, 10:25 am
Replacement versus Arthrodesis for Post-Traumatic Ankle Arthritis
Purpose: The purpose of this study was to compare the results of ankle arthrodesis with ankle joint replacement for posttraumatic arthritis of the ankle.
Methods: Over an 8-year period, 66 patients with 68 ankles that had end-stage posttraumatic arthritis of the ankle that had not responded to nonoperative treatment underwent either ankle replacement or arthrodesis at our institution. All patient records were retrospectively reviewed in an Institutional Review Board-approved study. Procedures included standard ankle fusion or the insertion of an Agility (DePuy) or S.T.A.R. (Link) Total Ankle Replacement (T.A.R.). All procedures and postoperative management were performed by the two senior authors, who had extensive experience with either operation. Required clinical follow-up for inclusion in this study was a minimum of 24 months. Postoperative radiographs, AOFAS scores (alignment, pain, and function), and videotaped gait analysis were evaluated. All complications, revisions, and conversions of T.A.R. to fusion were recorded.
Results: A total of 58 subjects, 14 men and 13 women with an average age of 55.4 years (range, 33 to 88), with 60 ankles were available for follow-up. There were 27 total ankle replacements (13 Agility, 14 STAR). There were 33 arthrodeses performed in 19 men and 14 women with an average age of 56.5 years (range, 35 to 77). Follow-up averaged 57 months (range, 24 to 96). The average AOFAS score for the combined replacement group was 71.1 (Agility, 73.4; STAR, 69.0). The average AOFAS score for the fusion group was 68.3. There was no significant difference between study groups in these AOFAS scores. The average total sagittal motion was 19.2° (range, 10° to 35°) for the arthrodesis group and 33° (range, 15° to 60°) for the arthroplasty group; this was a trend but was not statistically significant. Complications in the arthrodesis group included one deep infection. Complications in the arthroplasty group included two conversion arthrodeses, two arthroscopic synovectomies, five component revisions, one resection arthroplasty for infection, and four syndesmotic fusion nonunions. Overall, the rate of revision surgery was 3% for the arthrodesis group and 51.9% for the arthroplasty group. This difference was significant (P < 0.05).
Conclusion/Significance: Studies in the literature have suggested that ankle arthroplasty may be preferred over ankle arthrodesis for posttraumatic ankle arthritis. Although the arc of sagittal motion was greater in the TAR group secondary to combined ankle and subtalar motion, the clinical AOFAS scoring results were similar in both groups. Unfortunately, the rate of major complications requiring additional surgery was statistically significantly increased in the arthroplasty group. Our data suggest that ankle arthrodesis, when compared with ankle arthroplasty in the posttraumatic patient, although offering the patient a slightly decreased sagittal arc of motion, yields equivalent patient satisfaction with the significant advantage of fewer complications. At this time, we cannot recommend T.A.R. as a superior alternative to ankle arthrodesis for the patient with posttraumatic ankle arthritis.