Arthrodesis May Be Better Indicated After Failed TAR Than Re-Arthroplasty

Globally there has been a trend towards increased use of total ankle arthroplasty. This is partly due to an increase in the severity of ankle injuries sustained from either physical activity, or from degenerative diseases like arthritis and partly due to technological advancements in the field. With this increase, there comes an inevitable increase in the need to revise the prostheses, with component exchange and revision procedures often considered.

Australians surgeons however, do not seem to be following the trend, with a decreasing number of ankle replacement procedures being performed. From a peak in 2011 with 324 ankle replacements performed, the number in 2013 decreased to 251. This is a decrease of 24% in less than 24 months and given the leaps and bounds the industry is making forward from a technological standpoint, there no reason for this continued decline. Yet the trend is continuing into 2014 with only 90 arthroplasty procedures being performed so far.* Perhaps Australian surgeons have anecdotally found the same results as those of a recent US study, and are showing a preference for ankle fusion in place of total replacement.

A recent study reviewed 140 patients who underwent primary total ankle arthroplasty (TAR) and two types of revisions. The results demonstrated that patients with TAR may have better outcomes with ankle fusion, should they require a revision. This is a good indication why many surgeons are opting for the fusion procedure over the complete replacement.

To give some clarification, ankle fusion involves removing particular problematic surfaces of the joint, which promotes the tibia to 'fuse' with the talus. This draws upon the bodies natural tendency to heal itself after an injury. Prior to the rise of prosthetics, this was the primary method of treating degenerative joint injuries.

In an article in Orthopaedics Today Europe about the study results, investigator Ilka Kamrad, MD, stated that patients who underwent ankle fusion had similar function to those who underwent revision TAR, and both groups showed similar levels of satisfaction.

"Revision total ankle replacement does not seem to be superior to ankle fusion after a failed primary total ankle replacement, but larger study groups are needed to better compare the outcomes of the two procedures," Kamrad said during his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.

Perhap this a collective change in thought across the board for the orthopaedic fraternity, and fusion-based procedures will continue to rise into 2015 and beyond.