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Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis

Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis. Dan Preece DPM. Protocol / Criteria. S earch of the English-language literature spanning fifteen years, from January 1, 1990, to March 24, 2005.

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Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis

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  1. Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis Dan Preece DPM

  2. Protocol / Criteria • Searchof the English-language literature spanning fifteen years, fromJanuary 1, 1990, to March 24, 2005. • Follow up: minimum of two yearsor more after the operation, and at least ten patients inthe treatment group • All study designswere eligible, including: • randomized controlled trials, • prospectiveand retrospective nonrandomized controlled trials, and • uncontrolledcase series

  3. Outcomes: • patient-reported outcome scores, • mobility, • function, • pain, • revision or conversion to an arthrodesis, • implant survival, and • prosthetic loosening

  4. AOFAS Scale: • excellent defined as 90 to 100 points; • good, as 75 to 89 points; • fair, as 50 to 74 points; and • poor, as <50 points

  5. The duration of follow-up ranged from two to nine years in thestudies of total ankle arthroplasty and from two to twenty-threeyears in the studies of arthrodesis. • The average follow-up timefollowing the total ankle arthroplasties and the arthrodeseswas approximately five years • No studies directly compared total ankle arthroplastyand arthrodesis

  6. All ten studies of total ankle arthroplasty (including a totalof 852 patients) focused on second-generation total ankle implants including: • Agility and New JerseyLCS (DePuy, Warsaw Indiana), • Buechel-Pappas (Endotec, SouthOrange, New Jersey), • TNK (Kyocera, Kyoto, Japan), • STAR (WaldemarLink, Hamburg, Germany), and • Salto (Tornier, Montbonnot, France)prostheses

  7. Pt Characteristics: • Arthroplasty: mean age, fifty-eight years. Themajority of the patients were male(52%), with RA (39%). • Ankle arthrodesis: mean age, fifty years; predominately female (59%), 57% had OA.

  8. Arthroplasty: mean AOFAS score was78.2 points (95% confidence interval, 71.9 to 84.5). • Arthrodesis: mean AOFAS score was 75.6points(95% confidence interval, 71.6 to 79.6).

  9. Arthroplasty results: • excellent in 38% of the patients (95%confidence interval, 0% to 96.8%), • good in 30.5% (95% confidenceinterval, 21.0% to 39.9%), • fair in 5.5% (95% confidence interval,0% to 16.9%), and • poor in 24% (95% confidence interval, 0% to72.9%). • Arthrodesis results: • excellentin 31% (95% confidence interval, 19.8% to 41.5%), • good in 37%(95% confidence interval, 26.4% to 47.3%), • fair in 13% (95%confidence interval, 6.2% to 20.3%), • poor in 13% (95% confidenceinterval, 7.6% to 18.7%).

  10. The meta-analysis of binary outcome: • Arthroplasty • good: 78% (95% confidence interval, 61.9% to 95.0%) • poor: 22% (95% confidence interval, 4.9% to38.6%) • Arthrodesis studies • good: 73% (95%confidence interval, 61.2% to 84.1%) • poor: 27%(95% confidence interval, 16.0% to 38.8%)

  11. Arthroplasty: • 5-year survival rates:78% (95% confidence interval, 69.0% to 87.6%) • 10-year survival rates:77% (95%confidence interval, 63.3% to 90.8%). • Revision Rate: 7% (95% confidenceinterval, 3.5% to 10.9%) • Conversion to fusion rate: 5% (95% confidenceinterval, 2.0% to 7.8%) • BKA:1% of pts. • Arthrodesis: • Nonunion:10% (95% confidence interval, 7.4%to 12.1%) of the patients treated with ankle arthrodesis. • Revision Rate:9% (95% confidence interval, 5.5% to 11.6%) primarily because of nonunion. • BKA: 5%of the patients

  12. Conclusion: • intermediate and long-term outcomes analyzed inthis review do suggest that total ankle arthroplasty is comparable withankle arthrodesis. • The primary limitation of this review is that a direct comparative meta-analysisof total ankle arthroplasty and arthrodesis was not possible becausethere were no head-to-head trials.

  13. Source: Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis. The Journal of Bone and Joint Surgery (American). 2007;89:1899-1905.doi:10.2106/JBJS.F.01149

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