Patient-Centered Outcomes Following Total Ankle Arthroplasty vs. Total Ankle Arthrodesis: A Comparative Cohort Study Lauren M. Matheny, MPH; Daniel J. Liechti, MD; Nicholas S. Johnson, MD; Thomas O. Clanton, MD The Steadman Philippon Research Institute Vail, Colorado

Disclosures Thomas. O. Clanton, MD has the following disclosures: • Receives royalties for any biomaterial or orthopaedic product or device: Arthrex, Inc., Stryker, Inc. • Served on a speaker’s bureau or have been paid an honorarium to present by any biomaterial or orthopaedic product or device company: Arthrex, Inc., Stryker, Inc., Wright Medical Technology • Paid consultant for any biomaterial or orthopaedic device and equipment company, or supplier: Arthrex, Inc., Stryker, Inc., Wright Medical Technology • Receive research or institutional support as a principal investigator from any biomaterial orthopaedic device and equipment company, or supplier: Arthrex, Inc., Stryker, Inc. • Board member/committee appointment for a society: American Orthopaedic Foot and Ankle Society – IFFAS Council • Our research institution has received financial support from the following: Arthrex, Inc., ConMed LinvaTec, Opedix, Ossur Americas, Siemens Medical Solutions USA, Smith & Nephew Endoscopy No other authors have items to disclose.

Background • Ankle arthritis is a debilitating disorder that significantly limits activities of daily living  reduced quality of life • The two most common treatments for ankle arthritis, based on patient needs include: – Total ankle arthroplasty (TAA)

– Ankle Arthrodesis

• Few studies compare patient-centered outcomes following these two procedures

Purpose The purpose of this study was to compare patientcentered outcomes following total ankle arthroplasty and arthrodesis for the treatment of ankle arthritis.

Methods • Approved by an IRB • Patients between 1/2009 – 11/2013 who underwent TAA (3rd generation implant) or ankle arthrodesis by single surgeon for treatment of ankle arthritis included • Patients completed subjective questionnaire at minimum 2 years following index surgery

Methods Outcomes Measures: • • • •

Foot and Ankle Disability Index (FADI) Foot and Ankle Ability Measure (FAAM) Lysholm score Western Ontario and McMaster Universities Arthritis Index (WOMAC) • SF-12 physical component summary (PCS) and mental component summary (MCS) • Tegner activity scale • Patient satisfaction with outcome

Patient Selection

Results • 77 patients – 46 males, 31 females – Mean age = 60.2 years (range 30.2 - 78.4) – Mean BMI = 27.7 (range 17.0 - 39.1)

• 85% follow-up at mean 3.5 years (range 2.0 - 6.6) • Arthrodesis cohort significantly younger than TAA cohort (54.1 vs. 62.7 years) (P=.002) • 5 (7.8%) patients required revision surgery • No significant difference in failure rate between cohorts • Tegner only significant difference in outcome measures

Cohort Demographics Mean Age Gender BMI

Failures Mean time to failure

Total Ankle Arthroplasty

Ankle Arthrodesis

p-value

62.7 years (range 39.5 – 78.4)

54.1 years (range 30.2 – 75.9)

0.002

26 females, 29 males

5 females, 17 males

0.071

27.8 (18.6 – 39.1)

27.5 (range 17.0 – 37.6)

0.857

3

2

0.593

2.0 years (range 0.7 – 3.5 years)

0.3 years (range 0.2 – 0.4 years)

0.149

Comparison of Postoperative Outcomes Measures FADI Total FADI ADL FADI Sport FAAM Total FAAM ADL FAAM Sport Lysholm WOMAC Total SF-12 PCS SF-12 MCS *Tegner Activity Scale *Satisfaction with Outcome

Ankle Arthrodesis (n = 22)

Total Ankle Arthroplasty (n = 55)

p- value

76 (range 38 – 94) 83 (range 45 – 97) 53 (range 16 – 84) 73 (range 36 – 96) 80 (range 44 – 99) 53 (range 0 – 88) 75 (range 24 – 100) 14 (range 2 – 46)

74 (range 28 – 96) 82 (range 32 – 100) 46 (range 0 – 88) 72 (range 25 – 96) 82 (range 32 – 100) 45 (range 0 – 84) 78 (range 24 – 100) 15 (range 0 – 83) 47.1 (range 18.5 – 60.4) 55.2 (range 34.4 – 71.8) 3 (range 0 – 8) 9 (range 1 – 10)

0.660 0.826 0.336 0.830 0.799 0.336 0.591 0.958 0.944 0.844 0.007 0.465

48.5 (range 21.3 – 57.2) 55.8 (range 41.1 – 63.8) 4 (range 1 – 6) 9 (range 1 – 10)

*Denotes median values

Conclusions • Patients in both cohorts (TAA & arthrodesis) had similar low failure rates, function and satisfaction with outcome at final follow-up • Significantly lower activity level in TAA cohort which may be due to age difference between cohorts as previously described

Since good outcomes may be achieved with both TAA and arthrodesis, operative procedure should be matched based on patient expectations of activity and function

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