title: The mid-term outcome of total ankle arthroplasty and ankle fusion in rheumatoid arthritis: a systematic review.
abstract: BACKGROUND
  While arthrodesis is the standard treatment of a severely arthritic ankle joint, total ankle arthroplasty has become a popular alternative. This review provides clinical outcomes and complications of both interventions in patients with rheumatoid arthritis.
  
  
  METHODS
  Studies were obtained from Pubmed, Embase and Web of Science (January 1980-June 2011) and additional manual search.
  
  
  METHODS
  original clinical study, > 5 rheumatoid arthritis (population), internal fixation arthrodesis or three-component mobile bearing prosthesis (intervention), ankle scoring system (outcome). The clinical outcome score, complication- and failure rates were extracted and the methodological quality of the studies was analysed.
  
  
  RESULTS
  17 observational studies of 868 citations were included. The effect size concerning total ankle arthroplasty ranged between 1.9 and 6.0, for arthrodesis the effect sizes were 4.0 and 4.7. Reoperation due to implant failure or reoperation due to non-union, was 11% and 12% for respectively total ankle arthroplasty and arthrodesis. The methodological quality of the studies was low (mean 6.4 out of a maximum of 14 points) and was lower for arthrodesis (mean 4.8) as compared to arthroplasty (mean 7.8) (p = 0.04).
  
  
  CONCLUSIONS
  17 observational and no (randomized) controlled clinical trials are published on the effectiveness of arthroplasty or arthrodesis of the ankle in rheumatoid arthritis. Regardless of the methodological limitations it can be concluded that both interventions show clinical improvement and in line with current literature neither procedure is superior to the other.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: van Heiningen
authors.forename: Thea P M
authors.initials: TP
authors.lastname: Vliet Vlieland
authors.affiliation: Department of Orthopaedics J11-R74, Leiden University Medical Centre, P,O, box 9600, 2300 RC, Leiden, The Netherlands. H.J.L.van_der_Heide@lumc.nl.
authors.forename: Huub J L
authors.initials: HJ
authors.lastname: van der Heide
mesh_terms: D001172:Arthritis, Rheumatoid / Q000601:surgery*; D001174:Arthrodesis / Q000009:adverse effects; D058737:Arthroplasty, Replacement, Ankle / Q000009:adverse effects; D002986:Clinical Trials as Topic; D006801:Humans; D064887:Observational Studies as Topic; D016896:Treatment Outcome