• Orthopaedics Clinical Trials
• Orthopaedic Procedures
• Foot & Ankle Conditions

• Orthopaedics Clinical Trials
• Orthopaedics
• Orthopaedic Procedures
• Foot & Ankle Conditions

Bruce J. Sangeorzan, MD, Harborview Medical Center, Seattle, Washington, USA, described the results of Comparing Ankle Fusion to Ankle Replacement [NCT01620541], a study comparing ankle arthrodesis with ankle arthroplasty in patients with coronal deformity. The investigators performed a single-center chart and data review from a prospective pilot study in which senior surgeons used different implants from 2006 to 2011. Patients with ankle arthritis who underwent surgical treatment at Harborview Medical Center were included in this nonrandomized study. The patients all had varus or valgus > 10°. Patients with inflammatory or infectious arthritis were excluded, as were those with other limb disorders that affected their gait or outcome measures.

Outcome measures included the Musculoskeletal Functional Assessment (MFA), step counts, repeat surgery, and revision rates. The Peak Activity Index assessed the average steps per minute during the most active 30 minutes of the day. Patients were followed for a minimum of 2 years. Linear mixed effects regression was used to test whether changes in step activity or survey responses across follow-up differed by surgery type. The independent variables were time and type of surgery. The time of follow-up was modeled as 5 dummies—3, 6, 12, 24, and 36 months, which were cross-referenced with the type of surgery. The subject was the random effect. The main effect of interest was the interaction between follow-up and surgery type. All analyses were repeated, adjusting for age. A subset analysis of arthrodesis vs arthroplasty was carried out in patients who received a second-generation implant.

Charts and data were reviewed for 269 patients. Of these, 46 patients had coronal deformity > 10° and were > 2 years posttreatment; 19 patients were treated with arthrodesis and 27 with arthroplasty. Thirteen of the arthroplasty patients received an Agility implant and 14 received the Salto Talaris. The coronal deformity averaged 19.2° in the arthrodesis group and 17.6° in the arthroplasty group. There were no statistically significant differences in baseline activity or pain scores between the 2 groups.

No statistically significant difference in pain improvement between the arthrodesis and arthroplasty groups was observed. There were no differences in MFA scores and overall step counts between the 2 groups. At baseline, the MFA score was not significantly different between the 2 groups. Patients in the arthrodesis group slowly improved over time up to about 2 years but then started to decline; the arthroplasty group had more dramatic improvement early on, which then leveled out.

There was no apparent difference in outcomes between the 2 groups in patients with coronal tilt. The patients receiving a second-generation implant had significantly better age-adjusted Peak Activity Index results compared with the arthrodesis group. Five secondary surgical procedures were performed in the arthroplasty group 1 to 4.5 years after surgery, all in the Agility subgroup. The procedures were done for poly wear (n = 2), deformity recurrence (n = 1), nonunion syndesmosis (n = 1), and tibial subsidence (n = 1). In the fusion group, there was a secondary procedure for a nonunion and for a recurrent deformity.

The results of this study demonstrated no significant difference in outcomes between patients treated with arthrodesis and those with arthroplasty for coronal deformity.

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