The outcome of total ankle replacement

Abstract

We performed a systematic review and meta-analysis of modern total ankle replacements (TARs) to determine the survivorship, outcome, complications, radiological findings and range of movement, in patients with end-stage osteoarthritis (OA) of the ankle who undergo this procedure. We used the methodology of the Cochrane Collaboration, which uses risk of bias profiling to assess the quality of papers in favour of a domain-based approach. Continuous outcome scores were pooled across studies using the generic inverse variance method and the random-effects model was used to incorporate clinical and methodological heterogeneity. We included 58 papers (7942 TARs) with an interobserver reliability (Kappa) for selection, performance, attrition, detection and reporting bias of between 0.83 and 0.98. The overall survivorship was 89% at ten years with an annual failure rate of 1.2% (95% confidence interval (CI) 0.7 to 1.6). The mean American Orthopaedic Foot and Ankle Society score changed from 40 (95% CI 36 to 43) pre-operatively to 80 (95% CI 76 to 84) at a mean follow-up of 8.2 years (7 to 10) (p < 0.01). Radiolucencies were identified in up to 23% of TARs after a mean of 4.4 years (2.3 to 9.6). The mean total range of movement improved from 23° (95% CI 19 to 26) to 34° (95% CI 26 to 41) (p = 0.01). Our study demonstrates that TAR has a positive impact on patients' lives, with benefits lasting ten years, as judged by improvement in pain and function, as well as improved gait and increased range of movement. However, the quality of evidence is weak and fraught with biases and high quality randomised controlled trials are required to compare TAR with other forms of treatment such as fusion.

Time trends and risk factors for perioperative complications in total ankle arthroplasty: retrospective analysis using a national database in Japan

“…Refinement of implant design by adoption of mobile bearings and technological advances has gradually improved the clinical outcomes after TAA. A recent systematic review of recent TAA studies, reported an overall survivorship of 89 % at 10 years [1]. Based on improved clinical outcomes, TAA has become increasingly popular as an alternative to arthrodesis, which has long been the gold standard for treating end-stage ankle arthritis.…”

“…Although TAA has been recently popularized worldwide, it is still accompanied by higher rates of complications compared with total hip and knee arthroplasties [1, 13–15]. Surgeon understanding of the complications and their risk factors is important to provide good clinical outcomes; however, there is limited evidence available in the literature about risk factors for perioperative complications after TAA.…”

Pulmonary embolism and mortality following total ankle replacement: a data linkage study using the NJR data set

“…1 The National Institute for Healthcare and Clinical Excellence (NICE) risk assessment tool categorises TAR as a high-risk procedure for pulmonary embolism (PE), 2 but the true incidence of venous thromboembolism (VTE) following TAR is largely unknown, with several papers reporting a wide variation in incidence ranging from 0% to 4.8% (table 1). [3][4][5][6][7][8][9][10][11][12][13][14] These studies demonstrate ambiguity of definition of VTE; methodological flaws; and small single centre retrospective reviews.…”

Is End-Stage Ankle Arthrosis Best Managed with Total Ankle Replacement or Arthrodesis? A Systematic Review

“…Newer prosthesis is uncemented, comprises two or three modular components, and has improved outcomes. A recent systematic review reported 89% survival of 7942 TARs at 10 years and an improvement in American Orthopaedic Foot and Ankle Society score (AOFAS) from 40 to 80 at a mean of 8.2 years of follow-up [22]. However, a further review from Gougoulias et al of 1105 total ankle arthroplasties reported a 10% failure rate at 5 years with residual pain in 27%–60% of cases [23].…”