Pain After Ankle Arthroplasty (AA): Is Conversion to Total Ankle Arthrodesis (TAA) Truly Viable?

Debilitating ankle osteoarthritis (OA) affects a broad demographic of patients. Considerations for procedure selection between AA and TAA are numerous, though patient age consistently discourages for the use of TAA particularly in young patients with post-traumatic OA. These patients often undergo AA, but later face challenges with adjacent joint arthrosis. This situation presents an opportunity to convert AA to TAA.

But are these outcomes successful? 

According to a systematic review titled “Takedown of Ankle Arthrodesis and Conversion to Total Ankle Arthroplasty,” the answer is yes. Furthermore, the study, published last week, demonstrated that the improvements in AOFAS scores and visual analog scale scores for takedown TAA are comparable to those for primary TAA. Included within this review were studies with and without a native fibula, as well as those using a fibular prosthesis. As expected, TAA without a native fibula had higher rates of complications, primarily valgus collapse. In contrast, cases using a fibular prosthesis showed improved outcomes. 

The takeaway

AA takedown to TAA has shown better outcomes than we may have originally expected. Results are more favorable when a native fibula is preserved, so it’s advisable to avoid resecting the fibula during primary AA.