Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Apr;12(2):372-377.
doi: 10.1111/os.12635. Epub 2020 Mar 29.

Comparison of the Efficiency and Safety of Total Ankle Replacement and Ankle Arthrodesis in the Treatment of Osteoarthritis: An Updated Systematic Review and Meta-analysis

Yuhan Li  1 , Jinquan He  2 , Yongcheng Hu  3
Affiliations
Meta-Analysis

Comparison of the Efficiency and Safety of Total Ankle Replacement and Ankle Arthrodesis in the Treatment of Osteoarthritis: An Updated Systematic Review and Meta-analysis

Yuhan Li et al. Orthop Surg. 2020 Apr.

Abstract

While osteoarthritis is a common degenerative disease, ankle osteoarthritis is a subdivision that has received little attention. Two effective ways to treat osteoarthritis of the ankle are total ankle replacement (TAR) and ankle arthrodesis (AAD). Whether TAR or AAD is more beneficial for treatment is controversial. The purpose of this meta-analysis was to compare the efficiency (clinical outcome and patient satisfaction) and safety (complications and survival) of these two procedures. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed as a guideline for this study. Three electronic databases, PubMed, Web of Science, and Cochrane Library, were searched up to May 2019, with no language restrictions. Prospective or retrospective comparative studies were identified. The outcomes included clinical outcome, patient satisfaction, complications, and survival. Review Manager (Revman) 5.3 software was used to conduct the data analysis. We only selected literature from the past 5 years (no earlier than 2015). Seven comparative studies were included. There were six cohort studies and one cross-sectional study. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of cohort studies, and The Agency for Healthcare Research and Quality (AHRQ) checklist was chosen to assess the quality of cross-sectional studies. No significant difference was observed for efficiency and safety. Clinical outcome was included in five studies with four different scoring systems. Two of them used the American Orthopaedic Foot & Ankle Society (AOFAS) questionnaire scores to assess the two procedures (mean difference, -4.26; 95% confidence interval [CI], -11.37-2.85; P = 0.24; I2 = 1%). Patient satisfaction (risk ratio [RR], 0.96; 95% CI, 0.65-1.40; P = 0.82; I2 = 54%), complications (RR, 1.15; 95% CI, 0.16-8.21; P = 0.89; I2 = 84%), and survival (RR, 1.91; 95% CI, 0.33-11.08; P = 0.47; I2 = 90%) showed no significant difference between the TAR group and the AAD group. This meta-analysis showed no statistically significant difference between TAR and AAD in clinical outcome, patient satisfaction, complications, and survival. This revealed that TAR and AAD could appear to have similar results in these aspects. Therefore, the present results are not sufficient to conclude which of these two methods is better. Further studies are needed to obtain more clues.

Keywords: AAD; Ankle Arthrodesis; Meta-analysis; Osteoarthritis; TAR; Total Ankle Replacement.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study selection flow diagram (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses [PRISMA]).
Figure 2
Figure 2
Forest plot for clinical outcome (American Orthopaedic Foot & Ankle Society [AOFAS] questionnaire scores) comparison between total ankle replacement (TAR) and ankle arthrodesis (AAD) groups.
Figure 3
Figure 3
Forest plot for patient satisfaction comparison between total ankle replacement (TAR) and ankle arthrodesis (AAD) groups. [Correction added on 20 April 2020, after first online publication: figure 3 image has been corrected.]
Figure 4
Figure 4
Forest plot for complication comparison between total ankle replacement (TAR) and ankle arthrodesis (AAD) groups.
Figure 5
Figure 5
Forest plot for survival comparison between total ankle replacement (TAR) and ankle arthrodesis (AAD) groups.
See this image and copyright information in PMC

References

    1. Hochberg MC, Altman RD, Brandt KD, et al Guidelines for the medical management of osteoarthritis. Arthritis Rheum, 1995, 38: 1535–1540. - PubMed
    1. Horisberger M, Valderrabano V, Hintermann B. Posttraumatic ankle osteoarthritis after ankle‐related fractures. J Orthop Trauma, 2009, 23: 60–67. - PubMed
    1. Fuentes‐Sanz A, Moya‐Angeler J, López‐Oliva F, Forriol F. Clinical outcome and gait analysis of ankle arthrodesis. Foot Ankle Int, 2012, 33: 819–827. - PubMed
    1. Bestic JM, Peterson JJ, DeOrio JK, Bancroft LW, Berquist TH, Kransdorf MJ. Postoperative evaluation of the total ankle arthroplasty. Am J Roentgenol, 2008, 190: 1112–1123. - PubMed
    1. Demetracopoulos CA, Halloran JP, Maloof P, Adams SB, Parekh SG. Total ankle arthroplasty in end‐stage ankle arthritis. Curr Rev Musculoskelet Med, 2013, 6: 279–284. - PMC - PubMed