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Comparative Study
. 2011 Nov;35(11):1647-53.
doi: 10.1007/s00264-011-1336-1. Epub 2011 Aug 20.

Arthroplasty versus arthrodesis for end-stage ankle arthritis: decision analysis using Markov model

Dae Gyu Kwon  1 , Chin Youb Chung, Moon Seok Park, Ki Hyuk Sung, Tae Won Kim, Kyoung Min Lee
Affiliations
Comparative Study

Arthroplasty versus arthrodesis for end-stage ankle arthritis: decision analysis using Markov model

Dae Gyu Kwon et al. Int Orthop. 2011 Nov.

Abstract

Background: Total ankle arthroplasty and arthrodesis are the two mainstreams of treatment for end-stage ankle arthritis. This study was performed to determine which is a better choice for ankle arthritis, using a decision analysis and Markov model to reflect the repetitive nature of revision arthroplasty.

Methods: Based on current published evidence, a decision tree was constructed to compare the clinical outcomes of total ankle arthroplasty and arthrodesis, which contained the possible clinical events and the probabilities. Total ankle arthroplasty was subject to revision arthroplasty, and a Markov model was adopted for this branch to reflect this repetitive trait of the procedure. Arthrodesis could cause adjacent arthritis, and a conventional decision analysis model was adopted for this branch. Quality well-being index score was used for clinical outcome assessment, which was the utility in the decision tree. Sensitivity analysis was performed to test the stability of the decision tree and the threshold values.

Results: The model favoured total ankle arthroplasty over arthrodesis in terms of quality well-being index score. Sensitivity analysis showed that the model was considerably stable, unaffected by the changes in probabilities of failure after total ankle arthroplasty and adjacent arthritis after arthrodesis.

Conclusions: Based on current evidence, total ankle arthroplasty was found to be a better treatment than arthrodesis for ankle arthritis. Future development in the implant materials, improved understanding of ankle biomechanics, and surgical techniques will further enhance the clinical outcome of total ankle arthroplasty.

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Figures

Fig. 1
Fig. 1
Decision analysis tree with probability and utility variables. The decision node branches into total ankle arthroplasty and ankle arthrodesis. The total ankle arthroplasty branch adopts the Markov model
Fig. 2
Fig. 2
One-way sensitivity analysis showing that the model favours total ankle arthroplasty over ankle arthrodesis in terms of the quality of well-being index scores. a One-was sensitivity analysis for the probability of adjacent arthritis after arthrodesis. The decision model always favours the total ankle arthroplasty based on the reported ranges of the probability of adjacent arthritis after arthrodesis. b One-way sensitivity analysis for the probability of prosthetic survival in the total ankle arthroplasty. The total ankle arthroplasty was superior to ankle arthrodesis between the prosthetic survival rate of 65% and 95%, which was based on the previous reports
Fig. 3
Fig. 3
These graphs show one-way and two-way sensitivity analyses within a single cycle in patients aged between 45 and 54 years. a One-way sensitivity analysis on the utility of ankle arthrodesis. The decision model favours total ankle replacement in terms of the quality of well-being index scores regardless of the changes in the utility of ankle arthrodesis, of which the ranges were determined between the quality of well-being index scores with ankle arthritis and that without ankle arthritis. b One-way sensitivity analysis on the utility of total ankle replacement. The decision model favours total ankle replacement in terms of the quality of well-being index scores regardless of the changes in the utility of total ankle replacement, of which the ranges were determined between the quality of the well-being index scores with ankle arthritis and that without ankle arthritis. c Two-way sensitivity analysis showed that the decision model always favours total ankle replacement regardless of the changes in both utilities of ankle arthrodesis and total ankle replacement
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References

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