title: Intermediate-term results of total ankle replacement and ankle arthrodesis: a COFAS multicenter study.
abstract: BACKGROUND
  Surgical treatments for end-stage ankle arthritis include total ankle replacement and ankle arthrodesis. Although arthrodesis is a reliable procedure, ankle replacement is often preferred by patients. This prospective study evaluated intermediate-term outcomes of ankle replacement and arthrodesis in a large cohort at multiple centers, with variability in ankle arthritis type, prosthesis type, surgeon, and surgical technique. We hypothesized that patient-reported clinical outcomes would be similar for both procedures.
  
  
  METHODS
  Patients in the Canadian Orthopaedic Foot and Ankle Society (COFAS) Prospective Ankle Reconstruction Database were treated with total ankle replacement (involving Agility, STAR, Mobility, or HINTEGRA prostheses) or ankle arthrodesis by six subspecialty-trained orthopaedic surgeons at four centers between 2001 and 2007. Data collection included demographics, comorbidities, and the Ankle Osteoarthritis Scale (AOS) and Short Form-36 (SF-36) scores. The preoperative and latest follow-up scores for patients with at least four years of follow-up were analyzed. Sensitivity analyses excluded ankles that had undergone revision. A linear mixed-effects regression model compared scores between the groups, adjusting for age, sex, side, smoking status, body mass index, inflammatory arthritis diagnosis, baseline score, and surgeon.
  
  
  RESULTS
  Of the 388 ankles (281 in the ankle replacement group and 107 in the arthrodesis group), 321 (83%; 232 ankle replacements and eighty-nine arthrodeses) were reviewed at a mean follow-up of 5.5 ± 1.2 years. Patients treated with arthrodesis were younger, more likely to be diabetic, less likely to have inflammatory arthritis, and more likely to be smokers. Seven (7%) of the arthrodeses and forty-eight (17%) of the ankle replacements underwent revision. The major complications rate was 7% for arthrodesis and 19% for ankle replacement. The AOS total, pain, and disability scores and SF-36 physical component summary score improved between the preoperative and final follow-up time points in both groups. The mean AOS total score improved from 53.4 points preoperatively to 33.6 points at the time of follow-up in the arthrodesis group and from 51.9 to 26.4 points in the ankle replacement group. Differences in AOS and SF-36 scores between the arthrodesis and ankle replacement groups at follow-up were minimal after adjustment for baseline characteristics and surgeon.
  
  
  CONCLUSIONS
  Intermediate-term clinical outcomes of total ankle replacement and ankle arthrodesis were comparable in a diverse cohort in which treatment was tailored to patient presentation; rates of reoperation and major complications were higher after ankle replacement.
authors.affiliation: Division of Orthopaedic Surgery, St. Michael's Hospital, 800-55 Queen Street East, Toronto, ON M5C 1R6, Canada. E-mail address: danielst@smh.ca.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Daniels
authors.affiliation: Department of Orthopaedics, University of British Columbia, 560-1144 Burrard Street, Vancouver, BC V6Z 2A5, Canada.
authors.forename: Alastair S E
authors.initials: AS
authors.lastname: Younger
authors.affiliation: Department of Orthopaedics, University of British Columbia, 1000-1200 Burrard Street, Vancouver, BC V6Z 2C7, Canada.
authors.forename: Murray
authors.initials: M
authors.lastname: Penner
authors.affiliation: Department of Orthopaedics, University of British Columbia, 1000-1200 Burrard Street, Vancouver, BC V6Z 2C7, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Wing
authors.affiliation: Division of Orthopaedic Surgery, Vancouver Island Health Authority, 305-1120 Yates Street, Victoria, BC V8V 3M9, Canada.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Dryden
authors.affiliation: CIHR Canadian HIV Trials Network, St. Paul's Hospital, 620-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
authors.forename: Hubert
authors.initials: H
authors.lastname: Wong
authors.affiliation: Queen Elizabeth II Health Sciences Center, Halifax Infirmary, Room 4867, 1796 Summer Street, Halifax, NS B3H 3A7, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Glazebrook
mesh_terms: D000328:Adult; D000368:Aged; D001178:Arthroplasty / Q000009:adverse effects / Q000379:methods*; D058737:Arthroplasty, Replacement, Ankle / Q000009:adverse effects / Q000379:methods*; D002170:Canada; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis / Q000601:surgery*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D020127:Recovery of Function; D012086:Reoperation; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome