LONG-TERM RESULTS OF TOTAL ANKLE ARTHROPLASTY VERSUS ANKLE ARTHRODESIS: A FOLLOW-UP COFAS STUDY

The aims of our current paper are to update the long term (minimum 10 year follow-upp) clinical outcomes of Total Ankle Replacement (TAR) and Ankle Arthrodesis (AA) in our original prospective, multicentre cohort of ankle arthritis patients with validated scoring instruments The Canadian Orthopaedic Foot and Ankle Society (COFAS) multicenter Ankle Arthritis Outcome Study was established in January 2003 and includes four study centers: Dalhousie University/Queen Elizabeth II Health Sciences Center, University of Toronto/St. Michael's Hospital, University of British Columbia/St. Paul's Hospital, and Vancouver Island Health Authority. This study was approved by the local hospital ethics boards. All patients provided informed consent for study enrollment and for the surgical procedure prior to questionnaire administration. Patients enrolled in this study constitute a subgroup of the COFAS Prospective Ankle Reconstruction Database. This database includes all patients with symptomatic end-stage ankle arthritis of various etiologies who had undergone an unsuccessful trial of nonoperative treatment, gave informed consent for database enrollment, and were treated with total ankle replacement or ankle arthrodesis by one of six subspecialty-trained orthopaedic surgeons at the four centers. Inclusion in the present study required skeletal maturity, a complete preoperative data set, and ability and willingness to give informed consent. Exclusion criteria were substantial osteonecrosis of the talus, prior ankle arthrodesis or arthroplasty, active or prior infection, Charcot arthropathy, and obesity (a body mass index [BMI] of >35 kg/m2). The final decision regarding the surgical treatment selection (ankle replacement or arthrodesis) was reached by consensus between the surgeon and patient. Arthrodesis was recommended for younger patients and patients with comorbidities that compromised soft-tissue healing (e.g., diabetes or current smoking). Ankle replacement was recommended in patients who were sixty-five years of age or older. Patient assessments were completed by the orthopaedic surgeon preoperatively, at one year following surgery, and annually thereafter. Patient demographics, comorbidities, and diagnoses were recorded preoperatively. Operative details were collected prospectively with use of the Halifax Joint Replacement Registry Form, which was developed for the COFAS database. Clinical outcomes were recorded preoperatively and at each follow-up visit with use of the Foot and Ankle Follow-up Questionnaire developed by a coalition of ten orthopaedic associations, including the American Academy of Orthopaedic Surgeons. This questionnaire includes the Ankle Osteoarthritis Scale (AOS) and the Short Form-36 (SF-36) Standard Version 2.0 Health Survey[2]. Data collected at each study site were transferred to the central data site at the Queen Elizabeth II Health Sciences Center in Halifax, Nova Scotia, Canada. AA patients are less likely to have a reoperation- 29% vs 43% in TAR- (P=0.02). AA patients are more likely to have hardware removal − 14% vs 2% in TAR (P<0.01). TAR patients had a rate of implat failure of 10%. TAR patients had significantly better improvements in AOS disability and pain when comparing RAW scores but when adjusted for age, sex, inflammatory disease, diabetes, BMI and pre-operative outcome scores- there was no statistical difference betwee the two groupsClinical outcomes of TAA & AA Similar when adjusted for comorbidities. Reoperation rates higher for TAA.