Trial shows benefits of two forms of ankle surgery for osteoarthritis

Ankle Arthroscopy is the most effective when pain is due to contact between bone spurs and the arthritis has not yet caused significant cartilage damage. Arthroscopy can make an arthritic joint deteriorate more rapidly. Patients with advanced ankle osteoarthritis who undergo surgery see equally good outcomes from the two main surgical treatments for osteoarthritis, a new study led by UCL researchers has shown.

The TARVA randomised clinical trial compared total ankle joint replacement with ankle fusion (when the ankle joint is pinned to prevent movement). It was led by the Comprehensive Clinical Trials Unit at UCL, and involved 17 NHS Trusts across the UK.

The new study, published in Annals of Internal Medicine, analysed the outcomes from just over 280 patients aged between 50 and 85, half of whom had total ankle replacement and half had ankle fusion surgery. Both procedures are intended to relieve pain and restore movement that was lost due to advanced osteoarthritis.

The outcomes were measured using standard assessments which covered quality of life, pain levels and ability to carry out daily activities – including, where relevant, participation in sport. Patients were assessed before their operation and twelve months after surgery.

The study found that both total ankle replacement and ankle fusion improved patients' quality of life considerably, with overall no statistically significant differences between them. But when the ankle replacement type most used in the UK, a fixed bearing joint replacement, was looked at separately, it showed a significant improvement in clinical scores and quality of life over ankle fusion.

The study also found that total joint replacement saw better clinical outcomes than ankle fusion in patients with arthritis in surrounding joints. In ankle fusion, the shin bone is pinned to the talus, the uppermost bone in the foot. This prevents movement in the ankle joint, but movement is retained in the 30 other joints within the foot. All patients underwent an MRI scan before their operation, and 42% were found to have arthritis in surrounding joints, although many of them had no symptoms. Patients receiving joint replacement were found to have a better range of movement than those that underwent ankle fusion.

The research also highlighted some differences in complications following surgery between the two procedures. Patients undergoing total ankle replacement were more likely to see their wound take longer to heal than those having ankle fusion. Total ankle replacement was also more likely to result in some nerve damage than ankle fusion, leaving patients with numbness or tingling in the foot.

Reference:

Andrew J. Goldberg, Kashfia Chowdhury, Ekaterina Bordea, Iva Hauptmannova, James Blackstone, Deirdre Brooking, Elizabeth L. Deane, Stephen Bendall, Andrew Bing, Chris Blundell, Sunil Dhar, Andrew Molloy, Steve Milner, Mike Karski, Steve Hepple, Malik Siddique, David T. Loveday, Viren Mishra, Paul Cooke, Paul Halliwell, David Townshend, Simon S. Skene, Caroline J. Dor. Total Ankle Replacement Versus Arthrodesis for End-Stage Ankle Osteoarthritis. Annals of Internal Medicine, 2022; DOI: 10.7326/M22-2058