Comparison of 25 ankle arthrodeses and 25 replacements at 67 months' follow-up.

INTRODUCTION

In the treatment of osteoarthritis of the ankle, controversy persists between advocates of arthrodesis and of joint replacement.

HYPOTHESIS

Results of total ankle replacement (TAR) are equivalent to those of ankle arthrodesis (AA).

MATERIAL AND METHODS

A single-center continuous retrospective series included 50 patients (25 TAR, 25 AA) operated on by a single surgeon. TAR used the standard Salto mobile-bearing prosthesis, and arthrodesis used screws or plates. Results were assessed clinically on AOFAS score, visual analog scale (VAS) and satisfaction questionnaire, and radiologically on X-ray and CT. Survivorship in the 2 procedures was estimated on the Kaplan Meier method.

RESULTS

At a mean 67 months' follow-up (range, 40-105 months), mean AOFAS and VAS scores were significantly better in the AA group (74.1 and 1.9, respectively) than in the TAR group (67 and 3.5, respectively) (p<0.001). In the AA group, 80% of patients were satisfied or very satisfied, compared to 64% after TAR. Five-year survival without revision for non-union (AA) or implant removal (TAR) was similar between groups: AA, 96%; TAR, 90% (p=0.72). In contrast, survival with no revision procedures was significantly better with AA (96%) than TAR (75%) (p=0.03).

DISCUSSION

At 5 years, surgical revision rates were significantly greater than after standard Salto mobile-bearing TAR than for arthrodesis, notably due to onset of cysts; we therefore decided to abandon this implant.

LEVEL OF EVIDENCE

IV, comparative retrospective study.