title: Total ankle arthroplasty versus ankle arthrodesis: a comparative analysis of arc of movement and functional outcomes.
abstract: OBJECTIVE
  Few reports compare the contribution of the talonavicular articulation to overall range of movement in the sagittal plane after total ankle arthroplasty (TAA) and tibiotalar arthrodesis. The purpose of this study was to assess changes in ROM and functional outcomes following tibiotalar arthrodesis and TAA.
  
  
  METHODS
  Patients who underwent isolated tibiotalar arthrodesis or TAA with greater than two-year follow-up were enrolled in the study. Overall arc of movement and talonavicular movement in the sagittal plane were assessed with weight-bearing lateral maximum dorsiflexion and plantarflexion radiographs. All patients completed Short Form-12 version 2.0 questionnaires, visual analogue scale for pain (VAS) scores, and the Foot and Ankle Ability Measure (FAAM).
  
  
  RESULTS
  In all, 41 patients who underwent TAA and 27 patients who underwent tibiotalar arthrodesis were enrolled in the study. The mean total arc of movement was 34.2° (17.0° to 59.1°) with an average contribution from the talonavicular joint of 10.5° (1.2° to 28.8°) in the TAA cohort. The average total arc of movement was 24.3° (6.9° to 44.3°) with a mean contribution from the talonavicular joint of 22.8° (5.6° to 41.4°) in the arthrodesis cohort. A statistically significant difference was detected for both total sagittal plane movement (p = 0.00025), and for talonavicular motion (p < 0.0001). A statistically significant lower VAS score (p = 0.0096) and higher FAAM (p = 0.01, p = 0.019, respectively) was also detected in the TAA group.
  
  
  CONCLUSIONS
  TAA preserves more anatomical movement, has better pain relief and better patient-perceived post-operative function compared with patients undergoing fusion. The relative increase of talonavicular movement in fusion patients may play a role in the outcomes compared with TAA and may predispose these patients to degenerative changes over time.
  
  
  CONCLUSIONS
  TAA preserves more anatomic sagittal plane motion and provides greater pain relief and better patient-perceived outcomes compared with ankle arthrodesis. Cite this article: Bone Joint J 2016;98-B:634-40.
authors.affiliation: Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
authors.forename: D I
authors.initials: DI
authors.lastname: Pedowitz
authors.affiliation: Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Kane
authors.affiliation: Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Smith
authors.affiliation: Marshall University, 1600 Medical Center Dr, Huntington, WV 25701, USA.
authors.forename: H L
authors.initials: HL
authors.lastname: Saffel
authors.affiliation: Sidney Kimmel Medical College at Thomas Jefferson University, 1020 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: C
authors.initials: C
authors.lastname: Comer
authors.affiliation: Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Raikin
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D001174:Arthrodesis; D058737:Arthroplasty, Replacement, Ankle; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D013640:Tarsal Joints / Q000502:physiology; D064232:Visual Analog Scale; D055815:Young Adult
keywords: Ankle; Arthritis; Arthrodesis; Arthroplasty; Motion; Movement