title: Quality of Life in Bilateral Vs. Unilateral End-Stage Ankle Arthritis and Outcomes of Bilateral Vs. Unilateral Total Ankle Replacement.
abstract: BACKGROUND
  We performed a retrospective cohort study to compare preoperative health-related quality of life (HRQoL) between patients with bilateral and those with unilateral end-stage ankle arthritis. We also compared midterm outcomes in a subgroup of patients who had undergone staged bilateral total ankle replacement (TAR) with the outcomes in the group treated with unilateral TAR.
  
  
  METHODS
  The HRQoL before surgical treatment was compared between 53 patients with bilateral end-stage ankle arthritis identified from the Canadian Orthopaedic Foot and Ankle Society Prospective Ankle Reconstruction Database and 106 patients with unilateral arthritis selected from the same database. Short Form-36 (SF-36) and American Academy of Orthopaedic Surgeons Foot and Ankle Module (AAOS-FAM) scores were used to assess preoperative HRQoL. Midterm outcomes (implant survival, HRQoL, and reoperation and revision rates) were compared between 37 patients who had undergone staged bilateral TAR and 106 patients treated with unilateral TAR; all patients were followed for at least 2 years.
  
  
  RESULTS
  Preoperatively, patients with unilateral disease had a higher prevalence of posttraumatic arthritis, whereas patients with bilateral disease had a higher prevalence of primary and secondary arthritis (p < 0.001). The mean preoperative SF-36 physical component summary (PCS) score in the unilateral group was higher than that in the bilateral group (p < 0.002). The mean postoperative follow-up (and standard deviation) was 5.0 ± 2.0 years in the bilateral TAR group and 4.0 ± 1.8 years in the unilateral TAR group. The patients who underwent either unilateral or staged bilateral TAR demonstrated improved SF-36 PCS scores between the preoperative and postoperative evaluations (p < 0.001). The postoperative SF-36 PCS scores were similar between the patients with unilateral TAR and those with bilateral TAR (p = 0.70). Six ankles (6%) in the unilateral cohort and 6 ankles (8%) in the bilateral cohort required revision of the metal component (p = 0.52). The mean implant survival time was 10.9 years (95% confidence interval [CI] = 10.1 to 11.7 years) in the bilateral cohort and 9.2 years (95% CI = 8.5 to 9.8 years) in the unilateral cohort (p = 0.60).
  
  
  CONCLUSIONS
  Preoperative SF-36 scores demonstrated that bilateral end-stage ankle arthritis is a more debilitating condition than unilateral arthritis. Patients who underwent staged bilateral TAR benefited as much as patients who underwent unilateral TAR, despite having a worse preoperative health status. Metal component revision rates and implant survival were similar between the 2 groups.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: 1Division of Orthopaedic Surgery, St. Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada 2Dalhousie University, Halifax, Nova Scotia, Canada 3Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada 4Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada 5British Columbia's Foot and Ankle Clinic, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Sagar J
authors.initials: SJ
authors.lastname: Desai
authors.forename: Mark
authors.initials: M
authors.lastname: Glazebrook
authors.forename: Murray J
authors.initials: MJ
authors.lastname: Penner
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Wing
authors.forename: Alastair S E
authors.initials: AS
authors.lastname: Younger
authors.forename: Ellie
authors.initials: E
authors.lastname: Pinsker
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Daniels
mesh_terms: D001168:Arthritis / Q000209:etiology / Q000601:surgery*; D058737:Arthroplasty, Replacement, Ankle / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D011300:Preoperative Care; D011475:Prosthesis Failure; D011788:Quality of Life; D016896:Treatment Outcome