2.  Search of the English-language literature spanning fifteen years, from January 1, 1990, to March 24, 2005.  Follow up: minimum of two years or more after the operation, and at least ten patients in the treatment group  All study designs were eligible, including: › randomized controlled trials, › prospective and retrospective nonrandomized controlled trials, and › uncontrolled case series

3.  patient-reported outcome scores,  mobility,  function,  pain,  revision or conversion to an arthrodesis,  implant survival, and  prosthetic loosening

4.  AOFAS Scale: › excellent defined as 90 to 100 points; › good, as 75 to 89 points; › fair, as 50 to 74 points; and › poor, as <50 points

5.  The duration of follow-up ranged from two to nine years in the studies of total ankle arthroplasty and from two to twenty-three years in the studies of arthrodesis.  The average follow-up time following the total ankle arthroplasties and the arthrodeses was approximately five years  No studies directly compared total ankle arthroplasty and arthrodesis

6.  All ten studies of total ankle arthroplasty (including a total of 852 patients) focused on second-generation total ankle implants including: › Agility and New Jersey LCS (DePuy, Warsaw Indiana), › Buechel-Pappas (Endotec, South Orange, New Jersey), › TNK (Kyocera, Kyoto, Japan), › STAR (Waldemar Link, Hamburg, Germany), and › Salto (Tornier, Montbonnot, France) prostheses

7.  Arthroplasty : mean age, fifty-eight years. The majority of the patients were male (52%), with RA (39%).  Ankle arthrodesis : mean age, fifty years; predominately female (59%), 57% had OA.

8.  Arthroplasty : mean AOFAS score was 78.2 points (95% confidence interval, 71.9 to 84.5).  Arthrodesis : mean AOFAS score was 75.6 points (95% confidence interval, 71.6 to 79.6).

9.  Arthroplasty results :  excellent in 38% of the patients (95% confidence interval, 0% to 96.8%),  good in 30.5% (95% confidence interval, 21.0% to 39.9%),  fair in 5.5% (95% confidence interval, 0% to 16.9%), and  poor in 24% (95% confidence interval, 0% to 72.9%).  Arthrodesis results :  excellent in 31% (95% confidence interval, 19.8% to 41.5%),  good in 37% (95% confidence interval, 26.4% to 47.3%),  fair in 13% (95% confidence interval, 6.2% to 20.3%),  poor in 13% (95% confidence interval, 7.6% to 18.7%).

10.  Arthrodesis studies  good: 73% (95% confidence interval, 61.2% to 84.1%)  poor: 27% ( 95% confidence interval, 16.0% to 38.8%)  The meta-analysis of binary outcome:  Arthroplasty  good: 78% ( 95% confidence interval, 61.9% to 95.0%)  poor: 22% (95% confidence interval, 4.9% to 38.6%)

11.  Arthroplasty: › 5-year survival rates: 78% (95% confidence interval, 69.0% to 87.6%) › 10-year survival rates: 77% (95% confidence interval, 63.3% to 90.8% ). › Revision Rate: 7 % (95% confidence interval, 3.5% to 10.9%) › Conversion to fusion rate : 5% (95% confidence interval, 2.0% to 7.8%) › BKA: 1% of pts.  Arthrodesis: › Nonunion: 10% (95% confidence interval, 7.4% to 12.1%) of the patients treated with ankle arthrodesis. › Revision Rate: 9% (95% confidence interval, 5.5% to 11.6% ) primarily because of nonunion. › BKA: 5% of the patients

12.  intermediate and long-term outcomes analyzed in this review do suggest that total ankle arthroplasty is comparable with ankle arthrodesis.  The primary limitation of this review is that a direct comparative meta-analysis of total ankle arthroplasty and arthrodesis was not possible because there were no head-to-head trials.

13.  Source: Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis. The Journal of Bone and Joint Surgery (American). 2007;89:1899-1905. doi:10.2106/JBJS.F.01149