Abstract
Submission Type:
Ankle Arthritis
Research Type:
Level 2 - Prospective comparative study, Meta-analysis of Level 2 studies or Level 1 studies with inconsistent results
Introduction/Purpose:
Patients seeking surgical treatment for end stage ankle arthritis (ESAA) have two primary options: ankle arthrodesis (AA) and total ankle arthroplasty (TAA). It is imperative to understand the long-term comparative effectiveness of these two surgical options. The objectives of this study were to compare these two treatments and determine if the trajectory of improvement in patient reported outcomes in the first four years after surgery is sustained up to 8-years.
Methods:
A multisite prospective cohort study including 517 participants (414 TAA and 103 AA) presenting for surgical treatment after failed conservative management. Participants were compared during the interval 4 to 8 years post-surgery using the Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL) and sports scores, the Short Form-36 physical component summary (PCS) scores), pain scores (Chronic Pain Grade), and satisfaction with surgery. Overall satisfaction question was validated against the Nottingham Health Profile, SF-36, SF-12, Oxford-12, and the WOMAC. This IRB-approved prospective cohort study included six sites with recruitment beginning in May 2012 and ending in May 2015. Inclusion criteria ensured patients were suitable for both treatments while exclusion criteria were disabilities and diseases that effected ambulatory function. PRO were measured before surgery and at 12 month increments. All surgeons performed both procedures. Baseline differences were adjusted statistically.
Results:
All outcomes in both groups maintained strong improvement compared to pre-op (p <.0.0001). Mean eight-year improvement for the FAAM ADL and Sports scores was 27 (95% CI, 25-29) and 28 (95% CI, 25-31) points. Mean eight-year improvement in the SF-36 PCS was 8.6 (95% CI, 7.5-9.7) points and worst and average pain scales was 5.3 (95% CI, 5.0-5.6) and 4.0 (95% CI, 3.8-4.3) points, respectively. Those undergoing TAA maintained an 11 point (95% CI, 6-15) greater mean improvement in the FAAM ADL score than those undergoing AA (p <.0001).
Conclusion:
In conclusion, both established treatments for ESAA are effective maintaining pain relief and improving patient-reported functional outcomes. These gains are sustained over an eight-year period after surgery. While there is some attenuation in functional outcomes between four and eight years in both groups, this same attenuation is not observed in pain reduction. Despite both surgical approaches being effective, it appears TAA leads to greater improvement in most patient-reported outcome measures up to eight years after surgery.
