Total Ankle Arthroplasty Versus Ankle Arthrodesis: a Meta-Analysis Jordan Crafton, BS1, David Shofler, DPM, MSHS2 1 Second-year student, College of Podiatric Medicine, Western University of Health Sciences, 2 Assistant professor, College of Podiatric Medicine, Western University of Health Sciences RESULTS: Side by Side Comparison with Previous Study INTRODUCTION DEMOGRAPHICS RESULTS: Side by Side Comparison with Previous Study The choice of total ankle replacement or ankle fusion has been a debated topic for end-stage arthritis of the ankle joint. For many years, ankle arthrodesis was the gold standard for patients with end-stage ankle arthritis. A systematic review and meta-analysis led by Haddad et al assessed studies at a chronological end-point of March 2005. Nearly 10 years have passed since then. The goal of this meta-analysis was to serve as a comparative update, assessing the literature from April 2005-July 2014. Current Study Haddad et al. study Difference Total Ankle Arthroplasty Ankle Arthrodesis AOFAS 79.76 78.20 +1.56 72.61 75.60 -2.99 VAS 3.9 N/A 7.1 Excellent 14.29% 38% -23.71% 22.02% 31.00% -9.0% Good 71.76% 30.50% +41.26% 50.45% 37.00% +13.45% Fair 9.52% 5.50% +4.02% 17.41% 13.00% +4.41% Poor 4.43% 24% -19.57% 10.12% -2.88% Combined Excellent and Good 86.05% 68.50% +17.55% 72.47% 68% +4.47% 5-year survivorship 87.69% 78% +9.69% 10-year survivorship 75.91% 77% -1.09% Revision 13.65% 7% +6.65% 10.26% 9% +1.26% Amputation Rate 0.07% 1% -.03% 1.13% 5% -3.87% Total Ankle Arthroplasty Ankle Arthrodesis Female:Male 2807:2755 460:778 Mean Age 60.9 years 50 years Mean Duration of Follow up 51.3 months 54.2 months RESULTS Objective This current meta-analysis reviews the outcomes of total ankle arthroplasty and ankle arthrodesis, for the chronological period of April 2005-July 2014. Though the percentage of excellent subjective outcomes decreased compared to the earlier meta-analysis, the percentage of good subjective outcomes, as well as combined good/excellent subjective outcomes, substantially increased in the ankle arthroplasty group. The percentage of poor subjective outcomes decreased as well, though the implant revision rate slightly increased. RESULTS: Side by Side Comparison of Procedures Revisions and Amputations Total Ankle Arthroplasty Revsions/Ankles % Total Ankle Arthroplasty Revision Rate 1236/9079 13.61% Conversion to Arthrodesis Rate 168/9079 1.91% Amputation rate 6/9079 0.07% Most Common Causes of Revision Aseptic loosening/subsidence/persistent pain/implant failure 368/1236 29.77% Stiff ankle/impingement/bone fragments/pain/arthrofibrosis/bone overgrowth 105/1236 10.16% Varus or valgus deformity/instability/malalignment/deformity in general Infection 96/1236 9.30% PE insert/bearing subluxation/implant failure 95/1236 9.20% Conversion to Arthrodesis % of revisions 175/1236 16.94% Amputation % of revisions 6/1236 3.43% Ankle Arthrodesis Total Revisions Ankle Arthrodesis 152/1599 10.26% 16/1599 1.13% Non-union/unsatisfactory union/malalignment 49/152 32.24% 32/152 21.05% Hardware malfunction 24/152 15.79% Pain 16/152 10.53% CONCLUSIONS METHODS In the past 10 years, patient satisfaction following ankle arthroplasty has improved. This trend may be explained by improvements in implant technology and physician training. As a caution, revision rates have slightly increased as well. Ankle arthrodesis outcomes have not significantly changed during this time period. Two comprehensive literature searches of PubMed were conducted.  For one search, “ankle arthroplasty” was used as the search term; for the second search, the search term, “ankle arthrodesis” was used. Exclusion criteria were identical to those proposed by Haddad et al. While 317 articles were identified, 220 articles were excluded. This yielded 38 arthrodesis studies with 1508 ankles (1472 patients) and 52 arthroplasty studies with 7888 ankles (7642 patients).   REFERENCES 1.Haddad S.L, Coetzee J.C, Estok R, Fahrbach K, Banel D, and L. Nalysnyk. Intermediate and long-term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis A Systematic Review of the Literature. J Bone Joint Surg Am. 2007;89:1899-905. 2. Wood P.L.R, Sutton C., Mishra V., Suneja R. A randomised, controlled trial of two mobile bearing total ankle replacements. J Bone Joint Surg Br. 2009 91-B:69-74. 3. Ferkel , R.D., Hewitt M. Long-Term Results of Arthroscopic Ankle Arthrodesis. Foot Ankle Int 2005 26: 275. For more information: jcrafton@westernu.edu or dshofler@westernu.edu