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Archives of Orthopaedic and Trauma Surgery

Published in:

01-03-2005 | Original Article

Efficacy of total ankle replacement with meniscal-bearing devices: a systematic review and meta-analysis

Authors: Dirk Stengel, Kai Bauwens, Axel Ekkernkamp, Jörg Cramer

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2005

Abstract

Introduction

The reputation of total ankle arthroplasty for treating end-stage ankle arthritis of different origin is dubious. Newer generation meniscal-bearing prostheses may have overcome the known problems with earlier implants. There is, however, no systematic approach to the available scientific evidence allowing for a critical appraisal of their benefits and risks.

Materials and methods

We conducted a systematic review meta-analysis of studies exploring the efficacy of three-component total ankle prostheses. We demanded a minimum sample size of 20 subjects, at least 1 year of follow-up, and a clinically relevant study endpoint (for example, results of ankle scoring, ranges of motion [ROM], complications, and survival rates). We identified citations by electronic medical databases and a manual search. We made no restrictions for language. We used an eight-point quality scale to appraise methodological standards, and modeled outcomes by random-effects meta-regression analysis.

Results

Eighteen of 1830 citations including 1086 patients fulfilled our eligibility criteria. Studies met a median of four quality items (interquartile range 2–5). Outcome estimates did not depend on methodological quality. There was no evidence of strong heterogeneity or publication bias. With standardized 100-point ankle and hindfoot scores, formal data pooling was possible for 10 trials ( n =497), showing a mean improvement of 45.2 points (95% confidence interval [CI] 39.3–51.1). Overall ROM improved slightly (6.3°, 95%CI 2.2–10.5°). Weighted complication rates ranged from 1.6% (deep infections) to 14.7% (impingement). Secondary surgery had to be performed in 12.5%, whereas secondary arthrodesis was necessary in 6.3%. The weighted 5-year prosthesis survival rate averaged 90.6%.

Conclusions

Ankle arthroplasty improves pain and joint mobility in end-stage ankle arthritis. Its performance in comparison to the current reference standard (that is, ankle fusion) remains to be defined in a properly designed randomized trial.

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Anderson T, Montgomery F, Carlsson Å (2003) Uncemented STAR total ankle prostheses. Three to eight-year follow-up of fifty-one consecutive cases. J Bone Joint Surg Am 85:1321–1329

Anderson RB, Davis WH, Cohen BE, Pleimann JH (2004) A concurrent-controlled trial of the Link Orthopaedics Scandinavian Total Ankle Replacement (STAR) vs arthrodesis for treatment of degenerative ankle disease. Available online at http://www.millerclinic.com/miller_research/clinical_trials/

Bhandari M, Tornetta P, Ellis T, Audige L, Sprague S, Kuo JC, Swiontkowski MF (2004) Hierarchy of evidence: differences in results between non-randomized studies and randomized trials in patients with femoral neck fractures. Arch Orthop Trauma Surg 124:10–16CrossRef

Coester LM, Saltzman CL, Leupold J, Pontarelli W (2003) Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am 83:219–228

Cook RD, Weisberg S (1983) Diagnostics for heteroscedasticity in regression. Biometrika 70:1–10

Department of Health (2002) NHS performance indicators, February 2002. Available online at http://www.performance.doh.gov.uk/nhsperformanceindicators/2002/haesj_a.html

Ernst C, Ernst G, Szczesny E (2003) Does learning matter for knee replacement surgery? Financial Accountability and Management 19:375–396CrossRef

Giannini S, Leardini A, O’Connor JJ (2000) Total ankle replacement: review of the designs and of the current status. Foot Ankle Surg 6:77–88CrossRef

Greenland S (1994) Quality scores are useless and potentially misleading. Am J Epidemiol 140:300–301

10.

Guyton GP (2001) Theoretical limitations of the AOFAS scoring systems: an analysis using Monte Carlo modeling. Foot Ankle Int 22:779–787

11.

Hamblen DL (1985) Can the ankle joint be replaced? J Bone Joint Surg Br 67:689–690

12.

Hintermann B, Valderrabano V (2001) Endoprothetische Versorgung am oberen Sprunggelenk. Z Ärztl Fortbild Qualitätssich 95:187–194

13.

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay H (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

14.

Kerkhoffs GMMJ, Handoll HHG, Bie R de, Rowe BH, Struijs PAA (2004) Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults (Cochrane review). In: The Cochrane Library, issue 1. John Wiley & Sons, Chichester

15.

Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems fort the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353PubMed

16.

Knecht SI, Estin M, Callaghan JJ, Zimmerman MB, Alliman KJ, Alvine FG, Saltzman CL (2004) The Agility total ankle arthroplasty: seven to sixteen-year follow-up. J Bone Joint Surg Am 86:1161–1171

17.

Kofoed H, Sturup J (1994) Comparison of ankle arthroplasty and arthrodesis. A prospective series with long-term follow-up. Foot 4:1–9CrossRef

18.

Kofoed H, Sørensen TS (1998) Ankle arthroplasty for rheumatoid arthritis and osteoarthritis. J Bone Joint Surg Br 80:328–332CrossRef

19.

Landis JR, Koch GG (1997) The measurement of observer agreement for categorial data. Biometrics 33:159–174

20.

MacLehose RR, Reeves BC, Harvey IM, Sheldon TA, Russell IT, Black AM (2000) A systematic review of comparisons of effect sizes derived from randomised and non-randomised studies. Health Technol Assess 4:1–154

21.

Mazur JM, Schwartz E, Simon SR (1979) Ankle arthrodesis. Long-term follow-up with gait analysis. J Bone Joint Surg Am 61:964–975

22.

McGuire MR, Kyle RF, Gustilo RB, Premer RF (1988) Comparative analysis of ankle arthroplasty versus ankle arthrodesis. Clin Orthop 226:174–181

23.

Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet 354:1896–1900CrossRefPubMed

24.

National Audit Office (2000) Report by the Comptroller and Auditor General, NHS Executive. Hip replacements: getting it right first time. National Audit Office, London

25.

Parker MJ, Handoll HHG (2004) Replacement arthroplasty versus internal fixation for extracapsular hip fractures (Cochrane review). In: The Cochrane Library, issue 1. John Wiley & Sons, Chichester

26.

Parker RA, Berman NG (2003) Sample size: more than calculations. Am Stat 57:166–170

27.

Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT (2001) Statistical assessment of the learning curves of health technologies. Health Technol Assess 5:1–79

28.

SooHoo NF, Shuler M, Fleming LL (2003) Evaluation of the validity of the AOFAS clinical rating systems by correlation to the SF-36. Foot Ankle Int 24:50–55

29.

Spirt AA, Assal M, Hansen ST (2004) Complications and failure after total ankle arthroplasty. J Bone Joint Surg Am 86:1172–1178

30.

Stauffer RN, Chao EYS, Brewster RC (1977) Force and motion analyis of the normal, diseased, and prosthetic ankle joint. Clin Orthop 127:189–196PubMed

31.

Sutton AJ, Abrams KR, Jones DR, Sheldon TA, Song F (2000) Methods for meta-analysis in medical research. Wiley, Chichester, pp 109–132

32.

Thomas RH, Daniels TR (2003) Ankle arthritis. J Bone Joint Surg Am 85:923–936

33.

Thompson SG, Sharp SJ (1999) Explaining heterogeneity in meta-analysis: a comparison of methods. Stat Med 18:2693–2708CrossRefPubMed

34.

Thompson SG, Higgins JPT (2002) How should meta-regression analyses be undertaken and interpreted? Stat Med 21:1559–1573CrossRef

Title: Efficacy of total ankle replacement with meniscal-bearing devices: a systematic review and meta-analysis
Authors: Dirk Stengel
Kai Bauwens
Axel Ekkernkamp
Jörg Cramer
Publication date: 01-03-2005
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2005
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-004-0765-3

At a glance: The STEP trials

Springer Medicine

Efficacy of total ankle replacement with meniscal-bearing devices: a systematic review and meta-analysis

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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