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The mid-term outcome of total ankle arthroplasty and ankle fusion in rheumatoid arthritis: a systematic review.

van Heiningen J, Vliet Vlieland TP, van der Heide HJ - BMC Musculoskelet Disord (2013)

Bottom Line: The clinical outcome score, complication- and failure rates were extracted and the methodological quality of the studies was analysed. 17 observational studies of 868 citations were included.The effect size concerning total ankle arthroplasty ranged between 1.9 and 6.0, for arthrodesis the effect sizes were 4.0 and 4.7.Reoperation due to implant failure or reoperation due to non-union, was 11% and 12% for respectively total ankle arthroplasty and arthrodesis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedics J11-R74, Leiden University Medical Centre, P,O, box 9600, 2300 RC, Leiden, The Netherlands. H.J.L.van_der_Heide@lumc.nl.

ABSTRACT

Background: While arthrodesis is the standard treatment of a severely arthritic ankle joint, total ankle arthroplasty has become a popular alternative. This review provides clinical outcomes and complications of both interventions in patients with rheumatoid arthritis.

Methods: Studies were obtained from Pubmed, Embase and Web of Science (January 1980-June 2011) and additional manual search.

Inclusion criteria: original clinical study, > 5 rheumatoid arthritis (population), internal fixation arthrodesis or three-component mobile bearing prosthesis (intervention), ankle scoring system (outcome). The clinical outcome score, complication- and failure rates were extracted and the methodological quality of the studies was analysed.

Results: 17 observational studies of 868 citations were included. The effect size concerning total ankle arthroplasty ranged between 1.9 and 6.0, for arthrodesis the effect sizes were 4.0 and 4.7. Reoperation due to implant failure or reoperation due to non-union, was 11% and 12% for respectively total ankle arthroplasty and arthrodesis. The methodological quality of the studies was low (mean 6.4 out of a maximum of 14 points) and was lower for arthrodesis (mean 4.8) as compared to arthroplasty (mean 7.8) (p = 0.04).

Conclusions: 17 observational and no (randomized) controlled clinical trials are published on the effectiveness of arthroplasty or arthrodesis of the ankle in rheumatoid arthritis. Regardless of the methodological limitations it can be concluded that both interventions show clinical improvement and in line with current literature neither procedure is superior to the other.

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Correlation between study size and number of reported failures.
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Figure 2: Correlation between study size and number of reported failures.

Mentions: Regarding numbers of complications and failure there is a wide range among different studies. Doets et al. reported 29% perioperative fractures, as Anderson et al. did not report any fractures [2,23]. Furthermore studies which included a small number of patients e.g. De Palma et al. did not report failure. However studies with > 20 patients did [29]. Overall we find heterogeneity in the amount of complications. FigureĀ 2 visualizes a positive correlation Rho = 0.73 (p = 0.003) between study size and number of reported failure rate. When larger amounts of patients were included, higher failure rates were reported. Due to publication bias it is possible that only smaller series with good results were published. Whereas series with high complication- and, or failure rates will not be published.


The mid-term outcome of total ankle arthroplasty and ankle fusion in rheumatoid arthritis: a systematic review.

van Heiningen J, Vliet Vlieland TP, van der Heide HJ - BMC Musculoskelet Disord (2013)

Correlation between study size and number of reported failures.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231459&req=5

Figure 2: Correlation between study size and number of reported failures.
Mentions: Regarding numbers of complications and failure there is a wide range among different studies. Doets et al. reported 29% perioperative fractures, as Anderson et al. did not report any fractures [2,23]. Furthermore studies which included a small number of patients e.g. De Palma et al. did not report failure. However studies with > 20 patients did [29]. Overall we find heterogeneity in the amount of complications. FigureĀ 2 visualizes a positive correlation Rho = 0.73 (p = 0.003) between study size and number of reported failure rate. When larger amounts of patients were included, higher failure rates were reported. Due to publication bias it is possible that only smaller series with good results were published. Whereas series with high complication- and, or failure rates will not be published.

Bottom Line: The clinical outcome score, complication- and failure rates were extracted and the methodological quality of the studies was analysed. 17 observational studies of 868 citations were included.The effect size concerning total ankle arthroplasty ranged between 1.9 and 6.0, for arthrodesis the effect sizes were 4.0 and 4.7.Reoperation due to implant failure or reoperation due to non-union, was 11% and 12% for respectively total ankle arthroplasty and arthrodesis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedics J11-R74, Leiden University Medical Centre, P,O, box 9600, 2300 RC, Leiden, The Netherlands. H.J.L.van_der_Heide@lumc.nl.

ABSTRACT

Background: While arthrodesis is the standard treatment of a severely arthritic ankle joint, total ankle arthroplasty has become a popular alternative. This review provides clinical outcomes and complications of both interventions in patients with rheumatoid arthritis.

Methods: Studies were obtained from Pubmed, Embase and Web of Science (January 1980-June 2011) and additional manual search.

Inclusion criteria: original clinical study, > 5 rheumatoid arthritis (population), internal fixation arthrodesis or three-component mobile bearing prosthesis (intervention), ankle scoring system (outcome). The clinical outcome score, complication- and failure rates were extracted and the methodological quality of the studies was analysed.

Results: 17 observational studies of 868 citations were included. The effect size concerning total ankle arthroplasty ranged between 1.9 and 6.0, for arthrodesis the effect sizes were 4.0 and 4.7. Reoperation due to implant failure or reoperation due to non-union, was 11% and 12% for respectively total ankle arthroplasty and arthrodesis. The methodological quality of the studies was low (mean 6.4 out of a maximum of 14 points) and was lower for arthrodesis (mean 4.8) as compared to arthroplasty (mean 7.8) (p = 0.04).

Conclusions: 17 observational and no (randomized) controlled clinical trials are published on the effectiveness of arthroplasty or arthrodesis of the ankle in rheumatoid arthritis. Regardless of the methodological limitations it can be concluded that both interventions show clinical improvement and in line with current literature neither procedure is superior to the other.

Show MeSH
Related in: MedlinePlus