Background
Methods
Search strategy
Total ankle arthroplasty study selection
Study type | Inclusion criteria | Exclusion criteria |
---|---|---|
Total ankle arthroplasty studies | Published since January 2006 Third-generation implant approved for use in the USA Specific implants: HINTEGRA, STAR, Salto, INBONE Minimum of 200 ankles Report primary research Report complication, reoperation, and/or revision rate data | Revision data Duplicate data Non-consecutive series Restricted patient cohorts |
Ankle arthrodesis studies | Published since January 2006 Open and/or arthroscopic fusion technique Minimum of 80 ankles Report primary research Report complication, reoperation, and/or revision rate data | Revision data Duplicate data Non-consecutive series Restricted patient cohorts |
Total ankle arthroplasty vs. arthrodesis studies | Published since January 2006 Meet implant and fusion technique criteria stated above Report primary research | Revision data Duplicate data Non-consecutive series Restricted patient cohorts |
Ankle arthrodesis study selection
Total ankle arthroplasty versus ankle arthrodesis study selection
Data collection and analysis
Author | Year published | Study design | Recruitment period | Number of ankles | Prosthesis (TAA)/operative technique (AA) | Mean follow-up in years (range) | Mean age in years (range) |
---|---|---|---|---|---|---|---|
Total ankle arthroplasty (TAA) | |||||||
Gross et al. [14] | 2016 | Prospective | 2007–2013 | 455 | INBONE (219)/STAR (151)/Salto (85) | 3.7 | 62.0 |
Demetracopoulos et al. [15] | 2015 | Prospective | 2007–2011 | 395 | INBONE (214)/STAR (104)/Salto (77) | 3.5 (2–5.4) | 63.1 |
Lewis et al. [16] | 2015 | Prospective | 2007–2012 | 249 | INBONE | 3.3 | 63.2 |
Barg et al. [17] | 2013 | Retrospective | 2000–2010 | 722 | HINTEGRA | 6.3 ± 2.9 (2–12.2) | 61.1 ± 12.6 (19.8–90.0) |
Schenk et al. [18] | 2011 | Prospective | 2001–2007 | 218 | Salto | 3.5 | 56.8 ± 11.2 |
Wood et al. [19] | 2008 | Prospective | 1993–2000 | 200 | STAR | 7.3 (5–13) | 59.6 (18–83) |
Total/adjusted mean | 2008–2016 | Prospective (5) Retrospective (1) | 1993–2013 | 2239 | INBONE (682) STAR (455) Salto (380) HINTEGRA (722) | 4.8 years | 61.3 years |
Ankle arthrodesis (AA) | |||||||
Chalayon et al. [8] | 2015 | Retrospective | 2002–2013 | 215 | Open | NR | 56 ± 14 (18–88) |
Gordon et al. [9] | 2013 | Retrospective | 2004–2009 | 82 | Open | 3.9 (0.58–8.3) | 56.1 (18–75) |
Zwipp et al. [10] | 2010 | Retrospective | 1994–2000 | 94 | Open | 5.9 (4.8–7.8) | 53 (34–69) |
Nielsen et al. [11] | 2008 | Retrospective | 1994–2005 | 107 | Open (49)/arthroscopic (58) | NR | 51.92 (20–84) |
Muckley et al. [12] | 2007 | Retrospective | 1993–2001 | 137 | Open | 3.5 (1–7.5) | 49 (21–79) |
Total/adjusted mean | 2007–2015 | Retrospective (5) | 1993–2013 | 635 | Open (577) Arthroscopic (58) | 4.3 years | 53.4 years |
Complication rate | |||||||||
---|---|---|---|---|---|---|---|---|---|
Author | Number of ankles | Wound complications (n) | Fracture (n) | Deep infection (n) | TAA aseptic loosening/AA nonunion (n) | Overall rate (n) | Non-revision reoperation rate | Revision for implant failure (TAA) or revision fusion (AA) | Kaplan-Meier survivorship analysis |
Total ankle arthroplasty (TAA) | |||||||||
Gross et al. [14] | 455 | NR | NR | 1.5% (7) | NR | 14.1% (64) | NR | 3.1% (14) | NR |
Demetracopoulos et al. [15] | 395 | 6.6% (26) | NR | 0.8% (3) | NR | NR | 9.6% (38) | 5.1% (20) | NR |
Lewis et al. [16] | 249 | 8.4% (21) | 3.6% (9) | 1.2% (3) | 4.0% (10) | NR | 14.5% (36) |
8.4% (21) |
NR
|
Barg et al. [17] | 722 | NR | NR | 0.4% (3) | 5.8% (42) | NR | NR | 8.4% (61) | 94.0% at 5 years 84.0% at 10 years |
Schenk et al. [18] | 218 | 2.3% (5) | 2.3% (5) | 1.4% (3) | 1.8% (4) | NR | NR | 16.5% (36) | 86.6% at 5 years (95% CI 81.2–91.9) |
Wood et al. [19] | 200 | 2.5% (5) | 9.5% (19) | NR | 12.5% (25) | 32.5% (65) | 3.0% (6) | 12.0% (24) | 93.3% at 5 years (95% CI 89.8–96.8) 80.3% at 10 years (95% CI 71.0–89.6) |
Adjusted rate | 2239 | 5.4% (57/1062) | 4.9% (33/667) | 0.9% (19/2039) | 5.8% (81/1389) | 19.7% (129/655) | 9.5% (80/844) | 7.9% (176/2239) | |
Ankle arthrodesis (AA) | |||||||||
Chalayon et al. [8] | 215 | 14.4% (31) | 0.9% (2) | 5.1% (11) | 9.3% (20) | 40.9% (88) | 11.2% (24) | 7.4% (16) | NR |
Gordon et al. [9] | 82 | 2.4% (2) | 1.2% (1) | 0% (0) | 0% (0) | 20.7% (17) | 14.6% (12) | 0% (0) | NR |
Zwipp et al. [10] | 94 | 5.3% (5) | 0% (0) | 0% (0) | 1.1% (1) | 9.6% (9) | 3.2% (3) | 1.1% (1) | NR |
Nielsen et al. [11] | 107 | NR | NR | 2.8% (3) | 10.3% (11) | NR | 23.4% (25) | 4.7% (5) | NR |
Muckley et al. [12] | 110 | 10% (11) | 0.9% (1) | 7.3% (8) | 14.5% (16) | 19.1% (21) | NR | 10% (11) | NR |
Adjusted rate | 608 | 9.8% (49/501) | 0.8% (4/501) | 3.6% (22/608) | 7.9% (48/608) | 26.9% (135/501) | 12.9% (64/498) | 5.4% (33/608) |
Results
Total ankle arthroplasty
Ankle arthrodesis
Complications, reoperations, and revisions
Total ankle arthroplasty versus ankle arthrodesis
Author | Year | Study design | Number of ankles | Prosthesis (TAA) or operative technique (AA) | Mean/minimum follow-up (years) | Outcomes | Study conclusions |
---|---|---|---|---|---|---|---|
Braito et al. [20] | 2014 | Retrospective | 141 | TAA: HINTEGRA (101) AA: open (40) | TAA 4.2 (SD 2.03) AA 3.4 (SD 3.67) Minimum 6 months | Gait analysis AOFAS FAOS VAS Radiographic | No difference in cadence, stride length, or walking velocity No difference in mean global AOFAS No difference in adjacent joint arthritis |
Chopra et al. [21] | 2014 | Retrospective | 36 | TAA: Salto (12) AA: NR (12) Control: (12) | Minimum 2 years | Gait analysis | Altered bilateral gait mechanics in AA patients Relatively fully recovered bilateral gait mechanics in TAA patients |
Flavin et al. [22] | 2013 | Prospective | 42 | TAA: STAR (14) AA: NR (14) Control: (14) | Minimum 1 year | Gait analysis | No evidence of consistently superior gait function in TAA compared to AA |
Jastifer et al. [23] | 2014 | Prospective | 77 | TAA: STAR (61) AA: open (16) | Minimum 1 year | VAS Buechel-Pappas score AOFAS Patient satisfaction Functional outcomes | TAA with improved Buechel-Pappas scale (P = 0.036) and AOFAS (P = 0.03) over AA TAA with improved walking upstairs (P = 0.013), downstairs (P = 0.012), and uphill (P = 0.016) over AA |
Piriou et al. [24] | 2008 | Retrospective | 36 | TAA: Salto (12) AA: open (12) Control: (12) | Minimum 1 year | Gait analysis | AA with faster gait (P = 0.03), longer step length (P = 0.015) compared to replacement TAA with more symmetrical timing of gait (P = 0.015) and restored ground reaction force pattern over AA |
Rouhani et al. [25] | 2012 | Retrospective | 45 | TAA: Salto (11) AA: open (9) Ankle osteoarthritis (15) Control: (10) | TAA 22 months (13–47 months) AA 33 months (6–58 months) | Gait analysis AOFAS FFI | Significant improvements in foot mobility after TAR during 50 months gait Significant impairments remained in patients with AA during 50 months gait |
Saltzman et al. [26] | 2009 | Prospective | 672 | First phase TAA: STAR (158) AA: NR (66) Second phase TAA: STAR (448) | Up to 24 months | Complications Buechel-Pappas score | Significantly more wound complications (P = 0.011) and major complications (P = 0.045) and secondary surgical intervention in pivotal study TAA group over pivotal study AA group Significantly greater efficacy (P < 0.001) and overall success (P < 0.001) in pivotal STAR over AA The hypothesis of non-inferiority of ankle replacement was met for overall patient success |
Saltzman et al. [27] | 2010 | Retrospective | 71 | TAA: STAR (42) AA: (29) | TAA 3.8 (2.2–4.3) AA 4.8 (2.2–5.9) | Complications SF-36 AOS Radiographic | Improved outcome in TAA over AA for SF-36 MCS (P = 0.011) and AOS pain scale (P = 0.001) |
Schuh et al. [28] | 2012 | Retrospective | 41 | TAA: HINTEGRA (20) AA: open (21) | TAA 39.0 months (SD 17.0 months) AA 30.0 months (SD 22.0 months) | AOFAS UCLA score Satisfaction Functional outcomes | No significant differences between the groups concerning activity levels, participation in sports activities, UCLA, and AOFAS score |
Singer et al. [29] | 2013 | Retrospective | 44 | TAA: (17) AA: (17) Control: (10) | TAA 1.27 (SD 0.62) AA 1.60 (SD 0.65) | Gait analysis | Gait patterns more closely resemble normal gait for TAA cohort over AA cohort |