title: Comparison of quality of life following total ankle arthroplasty and ankle arthrodesis: Retrospective study of 54 cases.
abstract: BACKGROUND
  The benefit of ankle arthroplasty compared to arthrodesis continues to be debated, but the quality of life after these two interventions has rarely been assessed. We conducted a case-control study to compare quality of life and functional and athletic ability.
  
  
  OBJECTIVE
  Functional results, athletic ability, and quality of life after total ankle arthroplasty (TAA) are better than after ankle arthrodesis.
  
  
  METHODS
  Two continuous series of 59 TAAs and 46 arthrodeses (operated on between 1997 and 2009) were evaluated retrospectively using a questionnaire including the functional items of the AOFAS score, the Foot Function Index (FFI) score, the Foot Ankle Ability Measure (FAAM), and the SF-36.
  
  
  RESULTS
  Eighty-three responses (79% of the overall series) were matched in two groups: 32 TAAs [age at the intervention, 51.4years (range, 21-63years); follow-up, 52.2months (range, 30-146months); age at revision, 55.8years (range, 26-67years); BMI, 27.7 (range, 21.7-36.7)] and 22 arthrodeses [age at intervention, 50.1years (range, 24-72years); follow-up 57.9months (range, 12-147months); age at revision 54.9 years (range, 31-75years); BMI, 26.8 (range, 17.6-37)] (NS on all items between the two groups). The pain results were better after TAA, but with no statistically significant difference: AOFAS pain, (/40) 28.1±8.2 vs. 24.5±9.6; FFI pain, 16.6±18.8 vs. 24.3±21.5. The overall FFI score (/100) was better (P=0.048) after TAA (16.2±16.5 vs. 24.8±18.2). The overall mean athletic level compared to the state prior to the injury was relatively low in both groups, but significantly (p=0.007) higher in the TAA group: FAAM sports score (/100), 49.5±24.4 vs. 29.8±26.2. The quality-of-life scores, SF-36 physical health, mental health, and general health were not significantly different after TAA and arthrodesis: mental health score, 63.1±14.7 vs. 57.8±21.5; physical health score, 61.3±17.8 vs. 53.7±23.9, overall score, 63.2±16.4 vs. 55.9±23.5.
  
  
  CONCLUSIONS
  Very few publications describe activities and quality of life after TAA and arthrodesis. Despite weaknesses, this comparative study demonstrates a tendency toward better functional results after TAA than after ankle arthrodesis, without the difference between the two groups being very significant. On the other hand, there was no difference in terms of quality of life. After the doubts raised by publications on severe periprosthetic osteolysis at the intermediate term with certain TAA models, these results encourage pursuit of implantation and development of TAA.
  
  
  METHODS
  Comparative retrospective. Level III study.
authors.affiliation: Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique, Traumatologique et de Médecine du Sport, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France. Electronic address: fred.dalat@hotmail.fr.
authors.forename: F
authors.initials: F
authors.lastname: Dalat
authors.affiliation: Hospices Civils de Lyon, Hôpital Renée-Sabran, Service de Chirurgie Orthopédique, 83400 Hyères, France.
authors.forename: F
authors.initials: F
authors.lastname: Trouillet
authors.affiliation: Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique, Traumatologique et de Médecine du Sport, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Université Lyon 1, IFSTTAR, LBMC UMR-T 9406, Laboratoire de Biomécanique et Mécanique des Chocs, 69675 Bron cedex, France.
authors.forename: M H
authors.initials: MH
authors.lastname: Fessy
authors.affiliation: Université Lyon 1, IFSTTAR, LBMC UMR-T 9406, Laboratoire de Biomécanique et Mécanique des Chocs, 69675 Bron cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Bourdin
authors.affiliation: Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique, Traumatologique et de Médecine du Sport, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Université Lyon 1, IFSTTAR, LBMC UMR-T 9406, Laboratoire de Biomécanique et Mécanique des Chocs, 69675 Bron cedex, France. Electronic address: jean-luc.besse@chu-lyon.fr.
authors.forename: J-L
authors.initials: JL
authors.lastname: Besse
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis; D058737:Arthroplasty, Replacement, Ankle; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000523:psychology / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Ankle arthrodesis; Functional results; Quality of life; Total ankle arthroplasty