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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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Total ankle replacement versus arthrodesis (TARVA): protocol for a multicentre randomised controlled trial.

Andrew J Goldberg1, Razi Zaidi1, Claire Thomson2

  • 1UCL Institute of Orthopaedics and Musculoskeletal Science (IOMS), Royal National Orthopaedic Hospital (RNOH), London, UK.

BMJ Open
|September 8, 2016
PubMed
Summary

This study compares total ankle replacement (TAR) and ankle arthrodesis for end-stage ankle osteoarthritis. It aims to determine the most effective and cost-efficient surgical option for patients aged 50-85.

Keywords:
ankle arthrodesisankle replacementrandomised controlled trial

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Area of Science:

  • Orthopedics
  • Surgical Innovation
  • Clinical Trials

Background:

  • End-stage ankle osteoarthritis (OA) is managed by total ankle replacement (TAR) or ankle arthrodesis (fusion).
  • TAR popularity is rising, while fusion rates are static, with no clear guidelines on optimal treatment.
  • Existing comparative studies are observational, lacking randomization.

Purpose of the Study:

  • To compare the clinical and cost-effectiveness of TAR versus ankle arthrodesis for end-stage ankle OA.
  • To provide evidence-based guidance for managing end-stage ankle arthritis in patients aged 50-85.
  • To inform clinical decision-making and patient care.

Main Methods:

  • Multicenter randomized controlled trial (TARVA trial) involving 328 patients aged 50-85 with end-stage ankle arthritis.
  • Patients randomized to either TAR (164 patients) or ankle arthrodesis (164 patients).
  • Clinical assessments and patient-reported outcomes (Manchester Oxford foot questionnaire) collected preoperatively and at 6, 12, 26, and 52 weeks post-surgery.

Main Results:

  • Primary outcome: Manchester Oxford foot questionnaire at 12 months post-surgery.
  • Secondary outcomes: Quality of life, complication rates, revision surgery, reoperation rates, and health economic analysis.
  • Data collection ongoing; results to be disseminated via publications and presentations.

Conclusions:

  • The TARVA trial will provide crucial data on the comparative effectiveness of TAR and ankle arthrodesis.
  • Findings will guide the selection of the most appropriate surgical treatment for end-stage ankle OA.
  • The study aims to improve patient outcomes and optimize healthcare resource allocation.