Patient reported outcome measures in ankle replacement versus ankle arthrodesis - A systematic review

Compare the functional outcomes of comparative studies of ankle arthrodesis (AA) and total ankle replacements (TAR).

Systematic review using PRISMA guidelines.

Medline, Cochrane and EMBASE databases in July 2020.

Studies that directly compared TAR and AA which reported patient reported outcomes measures (PROMs) of pain, function and quality of life.

Two authors independently reviewed all papers. PROMs were allocated into pain, function or quality of life domains. Two summary statistics were created to allow for analysis of the PROMs. These statistics were the mean difference in post-operative score and the mean difference in the change of score.

1323 papers were assessed of which 20 papers were included. 898 ankle arthrodesis and 1638 ankle replacements were evaluated. The mean follow up was 3.3 years (range 0.5-13.0 years). AA patients had a mean age of 55.7 (range 20-82) and TAR 62.5 (range 21-89). There was major heterogeneity in outcomes used. We were unable to find a significant difference between the reported change in PROMs following TAR and AA. 29.3% of PROMs and their subscores showed TAR had better outcomes, 68.7% showed no significant difference and only 2.0% showed AA to have better outcomes.

The majority of published studies found equality in patient reported outcomes following TAR and AA although the quality of the studies was of low-level evidence. There is an urgent need for randomised controlled studies to definitively answer this important clinical question.