Aims Few reports compare the contribution of the talonavicular articulation to overall range of movement in the sagittal plane after total ankle arthroplasty (TAA) and tibiotalar arthrodesis. The purpose of this study was to assess changes in ROM and functional outcomes following tibiotalar arthrodesis and TAA.
Patients and Methods Patients who underwent isolated tibiotalar arthrodesis or TAA with greater than two-year follow-up were enrolled in the study. Overall arc of movement and talonavicular movement in the sagittal plane were assessed with weight-bearing lateral maximum dorsiflexion and plantarflexion radiographs. All patients completed Short Form-12 version 2.0 questionnaires, visual analogue scale for pain (VAS) scores, and the Foot and Ankle Ability Measure (FAAM).
Results In all, 41 patients who underwent TAA and 27 patients who underwent tibiotalar arthrodesis were enrolled in the study. The mean total arc of movement was 34.2° (17.0° to 59.1°) with an average contribution from the talonavicular joint of 10.5° (1.2° to 28.8°) in the TAA cohort. The average total arc of movement was 24.3° (6.9° to 44.3°) with a mean contribution from the talonavicular joint of 22.8° (5.6° to 41.4°) in the arthrodesis cohort. A statistically significant difference was detected for both total sagittal plane movement (p = 0.00025), and for talonavicular motion (p < 0.0001). A statistically significant lower VAS score (p = 0.0096) and higher FAAM (p = 0.01, p = 0.019, respectively) was also detected in the TAA group.
Conclusion TAA preserves more anatomical movement, has better pain relief and better patient-perceived post-operative function compared with patients undergoing fusion. The relative increase of talonavicular movement in fusion patients may play a role in the outcomes compared with TAA and may predispose these patients to degenerative changes over time.
Take home message: TAA preserves more anatomic sagittal plane motion and provides greater pain relief and better patient-perceived outcomes compared with ankle arthrodesis.
Cite this article: Bone Joint J 2016;98-B:634–40.
D. I. Pedowitz: Primary investigator, Developed protocol, Edited paper.
J. M. Kane: Corresponding author, Developed protocol, Wrote IRB, Wrote paper, Assisted in data collection, Primary role of measuring angles.
G. M. Smith: Data collection, Measuring angles.
H. L. Saffel: Data collection, Measuring angles, Literature review.
C. Comer: Data collection, Data entry, Measuring angles.
S. M. Raikin: Edited paper, Measured angles, Primary surgeon on all cases.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by G. Scott.
Supplementary material. Further information in the form of case studies is available alongside the online version of this article at www.bjj.boneandjoint.org.uk.
- Received July 13, 2015.
- Accepted November 13, 2015.
- ©2016 The British Editorial Society of Bone & Joint Surgery