title: Performance of total ankle arthroplasty and ankle arthrodesis on uneven surfaces, stairs, and inclines: a prospective study.
abstract: BACKGROUND
  Both total ankle arthroplasty (TAA) and ankle arthrodesis are options for the treatment of ankle arthritis and have been shown to improve gait postoperatively. Little is known about the postoperative performance of these patients on uneven surfaces.
  
  
  METHODS
  Between 2010 and 2013, 77 consecutive patients were enrolled in a prospective study and completed 12 months of follow-up. Patients received either a TAA (61 patients) or an ankle arthrodesis (16 patients). Preoperatively, at 6 months and 12 months postoperatively, patients were evaluated clinically and functionally on stairs, an inclined ramp, and an uneven surface. Patients graded their function on these surfaces using a visual analog scale (VAS) in addition to standard clinical grading scales.
  
  
  RESULTS
  There was no statistically significant difference between the patient groups preoperatively (all P > .05). Both TAA and ankle arthrodesis groups had high patient satisfaction, 3.5 and 3.4 out of 4.0, respectively. Both groups had improvement in Buechel-Pappas scores, VAS pain scores, AOFAS Ankle Hindfoot scores, and functional scores (all P values < .05). TAA patients had a significantly better outcome than the arthrodesis patients in the Buechel-Pappas scale (P = .036), AOFAS Ankle Hindfoot score (P = .03), ankle dorsiflexion (P < .001), ankle plantarflexion (P < .001), walking upstairs (P = .013), walking downstairs (P = .012), and walking uphill (P = .016).
  
  
  CONCLUSIONS
  Patients with TAA and ankle arthrodesis had improved performance walking on uneven surfaces at 12 months of follow-up compared to preoperatively. TAA patients had higher scores than the ankle arthrodesis patients walking upstairs, downstairs, and uphill.
  
  
  METHODS
  Level II, prospective cohort study.
authors.affiliation: Borgess Orthopedics, Kalamazoo, MI, USA jrjast@gmail.com.
authors.forename: James
authors.initials: J
authors.lastname: Jastifer
authors.affiliation: St. Alphonsus Medical Group, Boise, ID, USA St. Alphonsus Coughlin Clinic, Boise, ID, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Coughlin
authors.affiliation: St. Alphonsus Coughlin Clinic, Boise, ID, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hirose
mesh_terms: D000843:Ankle Joint / Q000601:surgery*; D001168:Arthritis / Q000601:surgery*; D001174:Arthrodesis; D058737:Arthroplasty, Replacement, Ankle; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D011446:Prospective Studies; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
keywords: ankle arthritis; ankle arthrodesis; ankle function; ankle replacement; total ankle arthroplasty