For patients with arthritis of the ankle, both total ankle arthroplasty (TAA) and ankle arthrodesis (AA) can improve patients’ gait pattern and function. Theoretically, the 2 benefits of TAA vs AA are less adjacent joint degeneration and improved overall function. However, even with TAA, patients are typically unable to recover a functionally normal gait [Flavin R et al. Foot Ankle Int. 2013]. In addition, there is little available information about how well these patients are able to postoperatively maneuver activities of daily living, such as climbing stairs and gentle hills and walking on uneven surfaces.

James R. Jastifer, MD, Borgess Bone & Joint Institute, Vicksburg, Michigan, USA, described a prospective cohort study that compared TAA with AA with regard to patients’ eventual ability to perform activities of daily living [Jastifer J et al. Foot Ankle Int. 2015]. The study initially included 95 patients with end-stage ankle arthritis who chose to undergo either TAA (n = 76) or AA (n = 19) between 2010 and 2013; the final results included 61 TAA patients and 16 AA patients.

At 6 months and 12 months postoperatively, patients were referred to see a physical therapist for clinical and functional evaluation on stairs, an inclined ramp, and an uneven surface. In addition, patients self-graded their function on these surfaces using a visual analog scale (VAS) in addition to standard grading metrics that included the Buechel-Pappas Scale, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, and patient satisfaction.

Preoperatively, there was no statistically significant difference between the patient groups. Postoperatively, patients in both groups expressed high levels of satisfaction with their activity. Both groups had significant improvement in Beuchel-Pappas scores, VAS pain scores, AOFAS scores, and functional scores for walking on flat surfaces, upstairs, downstairs, uphill, downhill, and uneven ground at 12 months (Tables 1 and 2). Patients who underwent TAA experienced a significantly better outcome than the AA patients in walking uphill (P < .016) as well as upstairs (P < .013) and downstairs (P < .012).

Dr Jastifer reviewed some limitations of the study, which included that fact that it was both nonrandomized and underpowered to find differences between the 2 groups relative to functional outcomes. He also explained that not much is known about the cutoff point for clinical significance regarding the difference in performance on uneven surfaces. He also suggested that there could have been a difference in outcomes if the study had been designed in 2, rather than 3, parts and that the study was limited by the use of only 1 degree of incline.

In summary, patients who underwent either TAA or AA improved in their ability to walk uphill and up- and downstairs from baseline to 12 months. However, there was a significant improvement in these 3 parameters among the TAA patients compared with those who underwent AA.