Freeman Hospital, United Kingdom.
Carlisle and District Primary Care Trust, United Kingdom.
Foot Ankle Int. 2020 Jul;41(7):767-774. doi: 10.1177/1071100720918880. Epub 2020 May 5.
Total ankle replacement (TAR) is becoming a more common alternative to ankle arthrodesis for the improvement of pain and function in end-stage arthritis of the ankle. The effects of end-stage arthritis of the ankle are similar to those of end-stage hip arthritis. There is a paucity of literature on patient-reported outcome measures (PROMs) following TARs in comparison with total hip replacement (THR) or total knee replacement (TKR). We aimed to study the 1-, 3-, and 5-year outcomes of TAR in comparison with TKR and THR.
PROMs data from patients who underwent a primary THR, TKR, or TAR performed between March 2008 and 2013 over a 5-year period were collected from our hospital patient registry. They were divided into 3 groups based on the type of primary joint replacement. Patient demographics and patient-reported outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], 36-item Short-Form (SF-36) scores, and patient satisfaction scores at follow-up) were compared preoperatively and at the 1-, 3-, and 5-year follow-ups.
There were data available on 2672 THR, 3520 TKR, and 193 TAR patients preoperatively. Preoperatively, TAR patients reported statistically significantly higher function scores when compared with THR and TKR patients (40 vs 33; = .001 [ < .05] and 40 vs 36; = .001 [ < .05]). For SF-36 scores, there was no statistically significant difference between groups for the general health and role emotional components ( = .171 and .064, respectively [ > .05]); TAR patients reported similar scores to TKR patients for physical domains at the 3- and 5-year follow-ups ( > .05), and TAR patients also reported similar scores to both THR and TKR patients for the mental domains ( > .05). At 5 years postoperatively, TAR patients reported lower scores than THR and TKR patients for function and stiffness. For SF-36 scores, TAR patients reported similar outcomes to THR and TKR patients for mental health components ( > .05), similar scores to TKR patients for 3 of 4 physical domains ( < .05), but lower satisfaction rates for activities of daily living (ADL) and recreation when compared with THR ( < .05).
TAR patients had similar outcomes to THR and TKR patients for disease-specific and mental health domains, and lower patient satisfaction rates in terms of pain relief, ADL, and recreation. Further research is warranted including clinical outcomes along with PROMs with a long-term follow-up.
Level III, retrospective comparative series.
全踝关节置换术（TAR）作为治疗踝关节终末期关节炎的一种更为常见的方法，可改善疼痛和功能。踝关节终末期关节炎的影响与髋关节终末期关节炎相似。与全髋关节置换术（THR）或全膝关节置换术（TKR）相比，关于 TAR 术后患者报告的结果测量（PROMs）的文献相对较少。我们旨在研究 TAR 与 TKR 和 THR 相比，在 1、3 和 5 年的结果。
我们从我院患者登记处收集了 2008 年 3 月至 2013 年期间进行的初次 THR、TKR 或 TAR 的患者的 PROMs 数据，随访时间为 5 年。根据初次关节置换的类型，将患者分为 3 组。比较术前和 1、3、5 年随访时的患者人口统计学资料和患者报告的结果（西安大略和麦克马斯特大学骨关节炎指数[WOMAC]、36 项简短表格（SF-36）评分和随访时的患者满意度评分）。
术前有 2672 例 THR、3520 例 TKR 和 193 例 TAR 患者的数据。术前，TAR 患者的功能评分明显高于 THR 和 TKR 患者（40 分比 33 分；=.001 [ <.05]和 40 分比 36 分；=.001 [ <.05]）。SF-36 评分方面，各组在一般健康和角色情感成分方面无统计学差异（=.171 和.064，分别[ >.05]）；TAR 患者在 3 年和 5 年随访时报告的物理领域评分与 TKR 患者相似（>.05），TAR 患者在精神领域也与 THR 和 TKR 患者报告的评分相似（>.05）。术后 5 年，TAR 患者的功能和僵硬评分低于 THR 和 TKR 患者。SF-36 评分方面，TAR 患者的心理健康成分与 THR 和 TKR 患者的结果相似（>.05），与 TKR 患者的 4 个物理领域中的 3 个（<.05）的评分相似，但与 THR 相比，日常生活活动（ADL）和娱乐的满意度较低（<.05）。
TAR 患者在疾病特异性和心理健康领域与 THR 和 TKR 患者的结果相似，但在缓解疼痛、ADL 和娱乐方面的患者满意度较低。需要进一步的研究，包括临床结果和长期随访的 PROMs。
III 级，回顾性比较系列。
