What Surgery Works Best for Arthritic Ankles?
Patients with advanced ankle osteoarthritis have two surgical options to restore their quality of life, and the good news is a new study shows both have good outcomes.
Deciding which one is better depends on the patient.
“Our aim in this trial was to provide the data that patients need to make informed decisions about these operations,” said study author Andrew Goldberg, a consultant orthopedic surgeon for University College London (UCL).
“We've clearly shown that both joint replacement and fusion provide significant patient benefits. We also found that the type of joint replacement seems to have an effect, but this needs further research,” he added in a university news release.
The study compared total ankle joint replacement with ankle fusion, a procedure where the ankle joint is pinned to prevent movement.
The trial included 280 patients aged 50 to 85 who underwent procedures meant to relieve pain caused by advanced osteoarthritis. Half had total ankle replacement, while the other half had ankle fusion surgery.
The researchers compared the two procedures, finding that both significantly improved patients' quality of life. Patients were assessed before their operation and 12 months after surgery.
The investigators then also looked at the type of total ankle replacement most used in the United Kingdom. Compared to ankle fusion, they found significant improvement in clinical scores and quality of life with this type of total ankle replacement.
Patients who also had osteoarthritis in surrounding joints had better clinical outcomes with total joint replacement than with ankle fusion. In ankle fusion, the shin bone is pinned to the foot's uppermost bone, the study authors explained, but while the ankle joint can't move, the 30 other joints within the foot still can.
About 42% of the patients had arthritis in the surrounding joints, according to an MRI done before their procedures, even though some had no pain in those joints.
Patients with joint replacement also had better range of movement than those with ankle fusion, the study found.
The "study shows how important it is to know the health of the surrounding joints before the patient undergoes surgery, which may involve an MRI, as it could help inform which procedure might be better for the patient,” said Goldberg, an honorary associate professor at UCL Surgery & Interventional Science.
Patient side effects after the procedures also differed.
Those with total ankle replacement required more time for their wounds to heal and were more likely to have some nerve damage.
Those who had ankle fusion surgery were more likely to experience blood clots in the legs because they were immobilized for longer. These could be treated with medication.
“This is the largest study of its kind to be completed in this field, providing robust findings, thanks to the teams across the U.K. who contributed and ensured high data quality,” said Kashfia Chowdhury, of the Comprehensive Clinical Trials Unit at UCL.
The findings were published Nov. 14 in the Annals of Internal Medicine. The study was funded by the National Institute for Health and Care Research.
The U.S. Centers for Disease Control and Prevention has more on osteoarthritis.
SOURCE: University College London, news release, Nov. 14, 2022