American Orthopaedic Foot & Ankle Society Annual Meeting

American Orthopaedic Foot & Ankle Society Annual Meeting

Issue: July 2012
June 22, 2012
2 min read

Comparison of total ankle replacement, ankle arthrodesis finds equivalent results

Issue: July 2012
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SAN DIEGO – Researchers found equivalent results when comparing patients who underwent either total ankle replacement or ankle fusion for end-stage ankle arthritis, according to a Roger A. Mann Award-winning study presented at the American Orthopaedic Foot and Ankle Society Annual Meeting here.

“We all know that there are two accepted treatment options for end-stage ankle arthritis: fusion and replacement,” Timothy R. Daniels, MD, FRCSC, said. “There are numerous publications – only three comparative studies — and all of them have short-term follow-up.”

Timothy R. Daniels, MD, FRCSC
Timothy R. Daniels, MD, FRCSC

The researchers conducted a retrospective cohort study, using prospectively collected data from the Canadian Orthopaedic Foot and Ankle Society ankle reconstruction database. The authors worked with a cohort of 366 patients who experienced conservative treatment failure for their end-stage ankle arthritis.

Index operations were performed before July 31, 2007, Daniels reported, with Ankle Osteoarthritis Scale (AOS), SF-36 and need for revision surgery serving as outcome measures.

Twenty-two patients were lost to follow-up. Of the remaining patients, 267 underwent total ankle replacements (TARs) and 99 underwent fusions. Average follow-up was 5 years.

Patients who had TARs fared better than the patients who had the ankle fusion in the AOS postoperative pain, postoperative disability score and SF-36 physical competence score, Daniels said. The revision rate was 14% for TARs and 7% for ankle fusions, with fusion revisions occurring within 2.5 years of the initial procedure. The revision rate for TAR remained constant throughout the follow-ups.

When the researchers adjusted scores for baseline characteristics or baseline SF-36 or AOS scores, they reported no statistically significant differences between the groups.

“Our midterm outcomes in total ankle replacement and fusions were equivalent in a diverse cohort of patients when treatment was tailored to the patient by six surgeons in four sites across the country,” Daniels said. “Both operations have the capacity to provide good results where appropriate selection has been made.”


  • Daniels TR, Younger ASE, Penner MJ, et al. COFAS multicenter study comparing total ankle replacement and ankle fusion: Mid-term results. Presented at the American Orthopaedic Foot and Ankle Society 2012 Annual Meeting. June 21-23. San Diego.
  • Disclosure: Daniels conducts paid presentations for, is a paid consultant for and receives research support from Biomimetic, Carticept and Integra.