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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2013

Open Access 01-12-2013 | Research article

The mid-term outcome of total ankle arthroplasty and ankle fusion in rheumatoid arthritis: a systematic review

Authors: Jacqueline van Heiningen, Thea PM Vliet Vlieland, Huub JL van der Heide

Published in: BMC Musculoskeletal Disorders | Issue 1/2013

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Abstract

Background

While arthrodesis is the standard treatment of a severely arthritic ankle joint, total ankle arthroplasty has become a popular alternative. This review provides clinical outcomes and complications of both interventions in patients with rheumatoid arthritis.

Methods

Studies were obtained from Pubmed, Embase and Web of Science (January 1980 – June 2011) and additional manual search. Inclusion criteria: original clinical study, > 5 rheumatoid arthritis (population), internal fixation arthrodesis or three-component mobile bearing prosthesis (intervention), ankle scoring system (outcome). The clinical outcome score, complication- and failure rates were extracted and the methodological quality of the studies was analysed.

Results

17 observational studies of 868 citations were included. The effect size concerning total ankle arthroplasty ranged between 1.9 and 6.0, for arthrodesis the effect sizes were 4.0 and 4.7. Reoperation due to implant failure or reoperation due to non-union, was 11% and 12% for respectively total ankle arthroplasty and arthrodesis. The methodological quality of the studies was low (mean 6.4 out of a maximum of 14 points) and was lower for arthrodesis (mean 4.8) as compared to arthroplasty (mean 7.8) (p = 0.04).

Conclusions

17 observational and no (randomized) controlled clinical trials are published on the effectiveness of arthroplasty or arthrodesis of the ankle in rheumatoid arthritis. Regardless of the methodological limitations it can be concluded that both interventions show clinical improvement and in line with current literature neither procedure is superior to the other.
Appendix
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Literature
1.
Fuchs S, Sandmann C, Skwara A, Chylarecki C: Quality of life 20 years after arthrodesis of the ankle: a study of adjacent joints. J Bone Joint Surg Br. 2003, 85 (7): 994-998. 10.1302/0301-620X.85B7.13984.CrossRefPubMed
2.
Doets HC, Brand R, Nelissen RG: Total ankle arthroplasty in inflammatory joint disease with use of two mobile-bearing designs. J Bone Joint Surg Am. 2006, 88 (6): 1272-1284. 10.2106/JBJS.E.00414.CrossRefPubMed
3.
Wood PL, Clough TM, Smith R: The present state of ankle arthroplasty. Foot Ankle Surg. 2008, 14 (3): 115-119. 10.1016/j.fas.2008.05.008.CrossRefPubMed
4.
Wood PL, Crawford LA, Suneja R, Kenyon A: Total ankle replacement for rheumatoid ankle arthritis. Foot Ankle Clin. 2007, 12 (3): 497-508. 10.1016/j.fcl.2007.05.002. viiCrossRefPubMed
5.
Haddad SL, Coetzee JC, Estok R, Fahrbach K, Banel D, Nalysnyk L: Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis: a systematic review of the literature. J Bone Joint Surg Am. 2007, 89 (9): 1899-1905. 10.2106/JBJS.F.01149.CrossRefPubMed
6.
Stengel D, Bauwens K, Ekkernkamp A, Cramer J: Efficacy of total ankle replacement with meniscal-bearing devices: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2005, 125 (2): 109-119. 10.1007/s00402-004-0765-3.CrossRefPubMed
7.
Gougoulias N, Khanna A, Maffulli N: How successful are current ankle replacements?: a systematic review of the literature. Clin Orthop Relat Res. 2010, 468 (1): 199-208. 10.1007/s11999-009-0987-3.CrossRefPubMed
8.
Kofoed H, Sorensen TS: Ankle arthroplasty for rheumatoid arthritis and osteoarthritis: prospective long-term study of cemented replacements. J Bone Joint Surg Br. 1998, 80 (2): 328-332. 10.1302/0301-620X.80B2.8243.CrossRefPubMed
9.
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M: Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994, 15 (7): 349-353. 10.1177/107110079401500701.CrossRefPubMed
10.
Budiman-Mak E, Conrad KJ, Roach KE: The foot function Index: a measure of foot pain and disability. J Clin Epidemiol. 1991, 44 (6): 561-570. 10.1016/0895-4356(91)90220-4.CrossRefPubMed
11.
Mazur JM, Schwartz E, Simon SR: Ankle arthrodesis: long-term follow-up with gait analysis. J Bone Joint Surg Am. 1979, 61 (7): 964-975.PubMed
12.
Naal FD, Impellizzeri FM, Rippstein PF: Which are the most frequently used outcome instruments in studies on total ankle arthroplasty?. Clin Orthop Relat Res. 2010, 468 (3): 815-826. 10.1007/s11999-009-1036-y.CrossRefPubMed
13.
MacDermid JC: An introduction to evidence-based practice for hand therapists. J Hand Ther. 2004, 17 (2): 105-117. 10.1197/j.jht.2004.02.001.CrossRefPubMed
14.
Shamliyan T, Kane RL, Dickinson S: A systematic review of tools used to assess the quality of observational studies that examine incidence or prevalence and risk factors for diseases. J Clin Epidemiol. 2010, 63 (10): 1061-1070. 10.1016/j.jclinepi.2010.04.014.CrossRefPubMed
15.
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J: Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003, 73 (9): 712-716. 10.1046/j.1445-2197.2003.02748.x.CrossRefPubMed
16.
Deeks JJ, Dinnes J, D'Amico R, Sowden AJ, Sakarovitch C, Song F, Petticrew M, Altman DG, International Stroke Trial Collaborative G: Evaluating non-randomised intervention studies. Health Technol Assess. 2003, iii-x (27): 1-173.
17.
Moran CG, Pinder IM, Smith SR: Ankle arthrodesis in rheumatoid arthritis: 30 cases followed for 5 years. Acta Orthop Scand. 1991, 62 (6): 538-543. 10.3109/17453679108994491.CrossRefPubMed
18.
Stranks GJ, Cecil T, Jeffery IT: Anterior ankle arthrodesis with cross-screw fixation: a dowel graft method used in 20 cases. J Bone Joint Surg Br. 1994, 76 (6): 943-946.PubMed
19.
Wood PLR, Clough TM, Jari S: Clinical comparison of two total ankle replacements. Foot Ankle Int. 2000, 21 (7): 546-550.PubMed
20.
Shinomiya F, Okada M, Hamada Y, Fujimura T, Hamada D: Indications of total ankle arthroplasty for rheumatoid arthritis: evaluation at 5 years or more after the operation. Mod Rheumatol. 2003, 13 (2): 153-159.CrossRefPubMed
21.
Kennedy JG, Harty JA, Casey K, Jan W, Quinlan WB: Outcome after single technique ankle arthrodesis in patients with rheumatoid arthritis. Clin Orthop Relat Res. 2003, 412: 131-138.CrossRefPubMed
22.
Bonnin M, Judet T, Colombier JA, Buscayret F, Graveleau N, Piriou P: Midterm results of the salto total ankle prosthesis. Clin Orthop Relat Res. 2004, 424: 6-18.CrossRefPubMed
23.
Anderson T, Montgomery F, Carlsson A: Uncemented STAR total ankle prostheses. J Bone Joint Surg Am. 2004, 86 (1): 103-111.PubMed
24.
Anderson T, Maxander P, Rydholm U, Besjakov J, Carlsson A: Ankle arthrodesis by compression screws in rheumatoid arthritis: primary nonunion in 9/35 patients. Acta orthopaedica. 2005, 76 (6): 884-890. 10.1080/17453670510045543.CrossRefPubMed
25.
Carlsson A, Markusson P, Sundberg M: Radiostereometric analysis of the double-coated STAR total ankle prosthesis: a 3–5 year follow-up of 5 cases with rheumatoid arthritis and 5 cases with osteoarthrosis. Acta orthopaedica. 2005, 76 (4): 573-579. 10.1080/17453670510041583.CrossRefPubMed
26.
San Giovanni TP, Keblish DJ, Thomas WH, Wilson MG: Eight-year results of a minimally constrained total ankle arthroplasty. Foot Ankle Int. 2006, 27 (6): 418-426.PubMed
27.
van der Heide HJ, Schutte B, Louwerens JW, van den Hoogen FH, Malefijt MC: Total ankle prostheses in rheumatoid arthropathy: outcome in 52 patients followed for 1–9 years. Acta orthopaedica. 2009, 80 (4): 440-444. 10.3109/17453670903153568.CrossRefPubMedPubMedCentral
28.
Lauge-Pedersen H, Knutson K, Rydholm U: Percutaneous ankle arthrodesis in the rheumatoid patient without débridement of the joint. Foot. 1998, 8 (4): 226-229. 10.1016/S0958-2592(98)90035-9.CrossRef
29.
De Palma L, Santucci A, Verdenelli A, Paladini P, Ventura A: Arthroscopic arthrodesis of the ankle in rheumatoid patients. Foot Ankle Surg. 2000, 6 (4): 261-266. 10.1046/j.1460-9584.2000.00221.x.CrossRef
30.
Guyatt G, Oxman AD, Sultan S, Brozek J, Glasziou P, Alonso-Coello P, Atkins D, Kunz R, Montori V, Jaeschke R: GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. J Clin Epidemiol. 2013, 66 (2): 151-157. 10.1016/j.jclinepi.2012.01.006.CrossRefPubMed
31.
Smith R, Wood PL: Arthrodesis of the ankle in the presence of a large deformity in the coronal plane. J Bone Joint Surg Br. 2007, 89 (5): 615-619.CrossRefPubMed
32.
SooHoo NF, Zingmond DS, Ko CY: Comparison of reoperation rates following ankle arthrodesis and total ankle arthroplasty. J Bone Joint Surg Am. 2007, 89 (10): 2143-2149. 10.2106/JBJS.F.01611.CrossRefPubMed
33.
Saltzman CL, Mann RA, Ahrens JE, Amendola A, Anderson RB, Berlet GC, Brodsky JW, Chou LB, Clanton TO, Deland JT: Prospective controlled trial of STAR total ankle replacement versus ankle fusion: initial results. Foot Ankle Int. 2009, 30 (7): 579-596. 10.3113/FAI.2009.0579.CrossRefPubMed
34.
Sowa DT, Krackow KA: Ankle fusion: a new technique of internal fixation using a compression blade plate. Foot & ankle. 1989, 9 (5): 232-240. 10.1177/107110078900900505.CrossRef
35.
Nelissen RG, Doets HC, Valstar ER: Early migration of the tibial component of the buechel-pappas total ankle prosthesis. Clin Orthop Relat Res. 2006, 448: 146-151.CrossRefPubMed
36.
Button G, Pinney S: A meta-analysis of outcome rating scales in foot and ankle surgery: is there a valid, reliable, and responsive system?. Foot Ankle Int. 2004, 25 (8): 521-525.CrossRefPubMed
37.
Schutte BG, Louwerens JW: Short-term results of our first 49 Scandanavian total ankle replacements (STAR). Foot Ankle Int. 2008, 29 (2): 124-127. 10.3113/FAI.2008.0124.CrossRefPubMed
38.
Ergina PL, Cook JA, Blazeby JM, Boutron I, Clavien PA, Reeves BC, Seiler CM, Balliol C, Altman DG, Aronson JK: Challenges in evaluating surgical innovation. Lancet. 2009, 374 (9695): 1097-1104. 10.1016/S0140-6736(09)61086-2.CrossRefPubMedPubMedCentral
39.
Coster M, Karlsson MK, Nilsson JA, Carlsson A: Validity, reliability, and responsiveness of a self-reported foot and ankle score (SEFAS). Acta orthopaedica. 2012, 83 (2): 197-203. 10.3109/17453674.2012.657579.CrossRefPubMedPubMedCentral
40.
Dawson J, Boller I, Doll H, Lavis G, Sharp R, Cooke P, Jenkinson C: Responsiveness of the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS, SF-36 and EQ-5D assessments following foot or ankle surgery. J Bone Joint Surg Br. 2012, 94 (2): 215-221.CrossRefPubMed
Metadata
Title
The mid-term outcome of total ankle arthroplasty and ankle fusion in rheumatoid arthritis: a systematic review
Authors
Jacqueline van Heiningen
Thea PM Vliet Vlieland
Huub JL van der Heide
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2013
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-14-306

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