title: Impact of complications in total ankle replacement and ankle arthrodesis analyzed with a validated outcome measurement.
abstract: BACKGROUND
  Major modifications in the design and techniques of total ankle replacement have challenged the perception that ankle arthrodesis is the treatment of choice for end-stage ankle arthritis. High complication and revision rates have been reported after both procedures.
  
  
  METHODS
  We performed radiographic evaluations at a mean of thirty-nine months following 114 total ankle replacements done with use of commonly used implants and at a mean of thirty-seven months following forty-seven ankle arthrodeses. The mean age was sixty-four years for the patients (fifty-one female and sixty-three male) who underwent total ankle replacement and fifty-nine years in the patients (fifteen female and thirty-two male) who underwent ankle arthrodesis. The impact of complications was analyzed with use of the Ankle Osteoarthritis Scale (AOS), a validated outcome instrument.
  
  
  RESULTS
  Both groups had significant improvement in the mean AOS score (p < 0.001). There was no significant difference in the mean improvement between the two groups (p = 0.96). The complication rate was 54% following total ankle replacement and 26% following ankle arthrodesis, which was a significant difference (p = 0.003). The impact of major complications on the AOS outcome score was significant in both the total ankle replacement group (p = 0.031) and the ankle arthrodesis group (p = 0.02).
  
  
  CONCLUSIONS
  At the time of follow-up, at a minimum of two years postoperatively, the outcomes of total ankle replacement and ankle arthrodesis, with regard to pain relief and function, were comparable. While the rate of complications was significantly higher following total ankle replacement, the impact of complications on outcome was clinically relevant in both groups.
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Berne, Freiburgstrasse, CH-3010 Berne, Switzerland. fabian.krause@insel.ch
authors.forename: Fabian G
authors.initials: FG
authors.lastname: Krause
authors.forename: Markus
authors.initials: M
authors.lastname: Windolf
authors.forename: Biraj
authors.initials: B
authors.lastname: Bora
authors.forename: Murray J
authors.initials: MJ
authors.lastname: Penner
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Wing
authors.forename: Alastair S E
authors.initials: AS
authors.lastname: Younger
mesh_terms: D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000009:adverse effects*; D058737:Arthroplasty, Replacement, Ankle / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000503:physiopathology / Q000601:surgery; D017063:Outcome Assessment, Health Care