Comparison of 25 ankle arthrodeses and 25 replacements at 67 months' follow-up.

Introduction: In the treatment of osteoarthritis of the ankle, controversy persists between advocates of arthrodesis and of joint replacement. Hypothesis: Results of total ankle replacement (TAR) are equivalent to those of ankle arthrodesis (AA). Material and

Methods: A single-center continuous retrospective series included 50 patients (25 TAR, 25 AA) operated on by a single surgeon. TAR used the standard Salto® mobile-bearing prosthesis, and arthrodesis used screws or plates. Results were assessed clinically on AOFAS score, visual analog scale (VAS) and satisfaction questionnaire, and radiologically on X-ray and CT. Survivorship in the 2 procedures was estimated on the Kaplan Meier method.

Results: At a mean 67 months' follow-up (range, 40-105 months), mean AOFAS and VAS scores were significantly better in the AA group (74.1 and 1.9, respectively) than in the TAR group (67 and 3.5, respectively) (p<0.001). In the AA group, 80% of patients were satisfied or very satisfied, compared to 64% after TAR. Five-year survival without revision for non-union (AA) or implant removal (TAR) was similar between groups: AA, 96%; TAR, 90% (p=0.72). In contrast, survival with no revision procedures was significantly better with AA (96%) than TAR (75%) (p=0.03). Discussion: At 5 years, surgical revision rates were significantly greater than after standard Salto® mobile-bearing TAR than for arthrodesis, notably due to onset of cysts; we therefore decided to abandon this implant. Level of evidence: IV, comparative retrospective study.