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.
