Foot & Ankle

Ankle replacement gaining traction in academic centres

Osteoarthritis of the ankle has been treated by both fusion and replacement for many years. However, unlike other large joints, the uptake of ankle replacement has been slow, with the majority of patients still being treated in most centres with ankle fusion. In part, this is due to perceived limitations in outcomes and longevity of ankle arthroplasty combined with technical difficulties of the surgery. Researchers in Philadelphia (USA) sought to establish what the state of play is with regards to treatment of ankle arthropathy and how this has changed over time. As arthroplasty is becoming a more widely accepted treatment and the indications refined, is it becoming more common place? The research team designed a national sample-based population study and identified patients through ICD-9-CM codes for ankle fusion and total ankle replacement. The inpatient sample identified 2666 replacements and 16,419 fusion operations within the sample which relates to an equivalent 13,145 and 80,426 arthroplasties and fusions, respectively, across the US. In terms of patterns of change over time, the study team identified a steady rise in ankle arthroplasties after 2006 which was particularly marked in larger academic centres. As time has gone on, the co-morbidity profiles of the two cohorts have started to even out, with a larger number of comorbid patients receiving ankle replacements than at the beginning of the study.⁴ Ankle replacement has yet to gain traction in widespread use, not necessarily a bad thing given the relatively narrow recommended indications. It is refreshing to see population-wide studies following the introduction of new treatments and a relatively conservative adoption across the board which is to be commended.