Document Detail


The outcome of total ankle replacement: a systematic review and meta-analysis.
MedLine Citation:
PMID:  24151270     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We performed a systematic review and meta-analysis of modern total ankle replacements (TARs) to determine the survivorship, outcome, complications, radiological findings and range of movement, in patients with end-stage osteoarthritis (OA) of the ankle who undergo this procedure. We used the methodology of the Cochrane Collaboration, which uses risk of bias profiling to assess the quality of papers in favour of a domain-based approach. Continuous outcome scores were pooled across studies using the generic inverse variance method and the random-effects model was used to incorporate clinical and methodological heterogeneity. We included 58 papers (7942 TARs) with an interobserver reliability (Kappa) for selection, performance, attrition, detection and reporting bias of between 0.83 and 0.98. The overall survivorship was 89% at ten years with an annual failure rate of 1.2% (95% confidence interval (CI) 0.7 to 1.6). The mean American Orthopaedic Foot and Ankle Society score changed from 40 (95% CI 36 to 43) pre-operatively to 80 (95% CI 76 to 84) at a mean follow-up of 8.2 years (7 to 10) (p < 0.01). Radiolucencies were identified in up to 23% of TARs after a mean of 4.4 years (2.3 to 9.6). The mean total range of movement improved from 23° (95% CI 19 to 26) to 34° (95% CI 26 to 41) (p = 0.01). Our study demonstrates that TAR has a positive impact on patients' lives, with benefits lasting ten years, as judged by improvement in pain and function, as well as improved gait and increased range of movement. However, the quality of evidence is weak and fraught with biases and high quality randomised controlled trials are required to compare TAR with other forms of treatment such as fusion.
Authors:
R Zaidi; S Cro; K Gurusamy; N Siva; A Macgregor; A Henricson; A Goldberg
Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  The bone & joint journal     Volume:  95-B     ISSN:  2049-4408     ISO Abbreviation:  Bone Joint J     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-10-23     Completed Date:  2013-12-31     Revised Date:  2014-11-05    
Medline Journal Info:
Nlm Unique ID:  101599229     Medline TA:  Bone Joint J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1500-7     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Ankle Joint / pathology,  surgery*
Arthroplasty, Replacement, Ankle / methods*,  mortality
Humans
Osteoarthritis / mortality,  surgery*
Quality of Life*
Range of Motion, Articular
Survival Rate
Treatment Outcome
Grant Support
ID/Acronym/Agency:
MC_U122886349//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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