Prospective Controlled Trial of STAR Total Ankle Replacement versus Ankle Fusion: Initial Results

Saltzman, Charles L.; Mann, Roger A.; Ahrens, Jeanette E.; Amendola, Annunziato; Anderson, Robert B.; Berlet, Gregory C.; Brodsky, James W.; Chou, Loretta B.; Clanton, Thomas O.; Deland, Jonathan T.; DeOrio, James K.; Horton, Greg A.; Lee, Thomas H.; Mann, Jeffrey A.; Nunley, James A.; Thordarson, David B.; Walling, Arthur K.; Wapner, Keith L.; Coughlin, Michael J.

doi:10.3113/fai.2009.0579

Cited by 373 publications

(261 citation statements)

References 55 publications

(47 reference statements)

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“…The cohort age and demographics reflect the mean age and demographics among participants in the largest TAA and ankle fusion studies [20,28]. The TAA study had approximately 50% females and 50% males [20]. The clinical pathway modeled began with patients undergoing a TAA or ankle fusion.…”

Section: Methodsmentioning

confidence: 99%

“…Three different fixedbearing implants and one newer mobile-bearing implant are approved for use in the United States. Some evidence suggests greater longevity in STAR mobile-bearing prostheses over standard fixed-bearing designs [16,20,28]. Furthermore, the study used for the reference case has the largest reported series of TAAs (200 patients), with some of the longest followup data published (range, 5-13 years), and greater than 80% survivorship [28].…”

Section: Methodsmentioning

confidence: 99%

“…Ankle fusion reduces pain at the cost of loss of ankle motion, altered gait kinematics [19,27], and accelerated arthritis in surrounding joints [5]. Patients also have a 3% to 10% risk of nonunion [13,20]. TAA in contrast offers greater ankle ROM, which may improve gait kinematics [19], decrease the stress on other joints, and potentially lead to less arthritis in surrounding joints.…”

Section: Introductionmentioning

confidence: 99%

“…TAA in contrast offers greater ankle ROM, which may improve gait kinematics [19], decrease the stress on other joints, and potentially lead to less arthritis in surrounding joints. However, TAA is more expensive and has its own complications including: implant loosening, ankle instability, osteolysis, higher infection rates, and higher reoperation rates [13,17,20,25].…”

Section: Introductionmentioning

confidence: 99%

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Is Total Ankle Arthroplasty A Cost-effective Alternative to Ankle Fusion?

Courville

Hecht

Tosteson

2011

Clinical Orthopaedics &Amp; Related Research

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Background Total ankle arthroplasty (TAA) implantation is increasing, as the potential for pain relief and restoration of function and risks are compared with those for ankle fusion. A previous analysis with a simple decision tree suggested TAA was cost-effective compared with ankle fusion. However, reevaluation is warranted with the availability of newer, more costly implants and longer-term patient followup data. Questions/purposes Considering all direct medical costs regardless of the payer, we determined if TAA remains a cost-effective alternative to ankle fusion when updated evidence is considered. Patients and Methods Using a Markov model, we evaluated expected costs and quality-adjusted life years (QALY) for a 60-year-old hypothetical cohort with endstage ankle arthritis treated with either TAA or ankle fusion. Costs were estimated from 2007 diagnosis-related group (DRG) and current procedural terminology (CPT) codes for each procedure. Rates were extracted from the literature. The incremental cost-effectiveness ratio (ICER), a measure of added cost divided by QALY gained for TAA relative to ankle fusion, was estimated. To identify factors affecting the value of TAA, sensitivity analyses were performed on all variables.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is Total Ankle Arthroplasty A Cost-effective Alternative to Ankle Fusion?

Courville

Hecht

Tosteson

2011

Clinical Orthopaedics &Amp; Related Research

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“…One report suggests patients have pain relief and high satisfaction after surgery [4]. Saltzman et al [33] recently published initial findings from a prospective controlled trial of the Scandinavian Total Ankle Replacement System 1 (STAR) TAA versus ankle fusion and reported TAA led to better function and similar pain relief compared with ankles that were fused. One study reported five TAAs in four patients with HH [6] and showed all four patients had good relief of symptoms after surgery.…”

Section: Introductionmentioning

confidence: 99%

Total Ankle Arthroplasty in Patients with Hereditary Hemochromatosis

Barg

Elsner

Hefti

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background More than half of patients with hereditary hemochromatosis (HH) have painful arthritis, often including hindfoot osteoarthritis. Total ankle arthroplasty (TAA) is increasingly recommended for patients with painful ankle osteoarthritis. However, the pain relief and function experienced by patients continues to be debated particularly as compared with ankle fusion. Questions/purposes We asked whether (1) the complication rates were low; (2) the components were stable; (3) the patients achieved pain relief; and (4) the patients had satisfactory midterm function, ROM, and quality of life. Patients and MethodsWe retrospectively reviewed all 16 prospectively followed patients (21 implants) with HH who underwent ankle arthroplasty. They had an average age of 59.5 years at the time of surgery. We obtained a visual analog scale for pain, the SF-36, and the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. Component stability was assessed using weightbearing radiographs. The minimum followup was 3.1 years (average, 5.3 years; range, 3.1-8.6 years).Results Postoperatively, one patient had débridement of a painful cyst on the tibial side and one patient had a subfibular débridement with a lateral ligament reconstruction. The tibial and talar components were stable in all ankles. The average pain score decreased from 6.7 (range, 3-10) to 1.9 (range, 0-4). All eight categories of SF-36 score showed improvement. The hindfoot score increased from 46 (range, 22-67) to 84 (range, 74-94). Conclusions Our data suggest TAA in patients with ankle osteoarthritis secondary to HH is associated with a low risk of postoperative complications and produces pain relief and good function.

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Emerging Arthroplasties

Peck¹

2012

Advances in Small Animal Total Joint Replacement

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Prospective Controlled Trial of STAR Total Ankle Replacement versus Ankle Fusion: Initial Results

Abstract: By 24 months, ankles treated with STAR ankle replacement (in both the Pivotal and Continued Access Groups) had better function and equivalent pain relief as ankles treated with fusion.

Cited by 373 publications

References 55 publications

Is Total Ankle Arthroplasty A Cost-effective Alternative to Ankle Fusion?

Is Total Ankle Arthroplasty A Cost-effective Alternative to Ankle Fusion?

Total Ankle Arthroplasty in Patients with Hereditary Hemochromatosis

Emerging Arthroplasties

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