International Orthopaedics

, Volume 36, Issue 6, pp 1207–1214 | Cite as

Total ankle arthroplasty versus ankle arthrodesis. Comparison of sports, recreational activities and functional outcome

  • Reinhard SchuhEmail author
  • Jochen Hofstaetter
  • Martin Krismer
  • Roberto Bevoni
  • Reinhard Windhager
  • Hans-Joerg Trnka
Original Paper



Ankle arthrodesis (AAD) and total ankle replacement (TAR) are the major surgical treatment options for severe ankle arthritis. There is an ongoing discussion in the orthopaedic community whether ankle arthrodesis or ankle fusion should be the treatment of choice for end stage osteoarthritis. The purpose of this study was to compare the participation in sports and recreational activities in patients who underwent either AAD or TAR for end-stage osteoarthritis of the ankle.


A total of 41 patients (21 ankle arthrodesis /20 TAR) were examined at 34.5 (SD18.0) months after surgery. At follow-up, pre- and postoperative participation in sports and recreational activities has been assessed. Activity levels were determined using the ankle activity score according to Halasi et al. and the University of California at Los Angeles (UCLA) activity scale. Clinical and functional outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. The percentage of patients participating in sports and recreational activities, UCLA score and AOFAS score were compared between both treatment groups.


In the AAD group 86% were active in sports preoperatively and in the TAR group this number was 76%. Postoperatively in both groups 76% were active in sports (AAD, p = 0.08). The UCLA score was 7.0 (± 1.9) in the AAD group and 6.8 (± 1.8) in the TAR group (p = 0.78). The AOFAS score reached 75.6 (± 14) in the AAD group and 75.6 (± 16) in the TAR group (p = 0.97). The ankle activity score decrease was statistically significant for both groups (p = 0.047).


Our study revealed no significant difference between the groups concerning activity levels, participation in sports activities, UCLA and AOFAS score. After AAD the number of patients participating in sports decreased. However, this change was not statistically significant.


Sport Activity Total Ankle Arthroplasty Ankle Arthrodesis Nordic Walking Total Ankle Replacement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Saltzman CL, Zimmerman MB, O’Rourke M, Brown TD, Buckwalter JA, Johnston R et al (2006) Impact of comorbidities on the measurement of health in patients with ankle osteoarthritis. J Bone Joint Surg Am 88:2366–2372PubMedCrossRefGoogle Scholar
  2. 2.
    Jerosch J, Steinbeck J, Schroder M, Reer R (1996) Arthroscopically assisted arthrodesis of the ankle joint. Arch Orthop Trauma Surg 115:182–189PubMedCrossRefGoogle Scholar
  3. 3.
    Stengel D, Bauwens K, Ekkernkamp A, Cramer J (2005) Efficacy of total ankle replacement with meniscal-bearing devices: a systematic review and meta-analysis. Arch Orthop Trauma Surg 125:109–119PubMedCrossRefGoogle Scholar
  4. 4.
    Cheng YM, Huang PJ, Hung SH et al (2000) The surgical treatment for degenerative disease of the ankle. Int Orthop 24:36–39PubMedCrossRefGoogle Scholar
  5. 5.
    Nishikawa M, Tomita T, Fujii M et al (2004) Total ankle replacement in rheumatoid arthritis. Int Orthop 28:123–126PubMedCrossRefGoogle Scholar
  6. 6.
    Zhao H, Yang Y, Yu G, Zhou J (2011) A systematic review of outcome and failure rate of uncemented Scandinavian total ankle replacement. Int Orthop 35:1751–1758Google Scholar
  7. 7.
    Mohamedean A, Said HG, El-Sharkawi M, El-Adly W, Said GZ (2009) Technique and short-term results of ankle arthrodesis using anterior plating. Int Orthop 34:833–837PubMedCrossRefGoogle Scholar
  8. 8.
    Kwon DG, Chung CY, Park MS et al (2011) Arthroplasty versus arthrodesis for end-stage ankle arthritis: decision analysis using Markov model. Int Orthop 35:1647–1653PubMedCrossRefGoogle Scholar
  9. 9.
    Haddad SL, Coetzee JC, Estok R, Fahrbach K, Banel D, Nalysnyk L (2007) Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature. J Bone Joint Surg Am 89:1899–1905PubMedCrossRefGoogle Scholar
  10. 10.
    Valderrabano V, Hintermann B, Nigg BM et al (2003) Kinematic changes after fusion and total replacement of the ankle: part 2: Movement transfer. Foot Ankle Int 24:888–896PubMedGoogle Scholar
  11. 11.
    Valderrabano V, Hintermann B, Nigg BM et al (2003) Kinematic changes after fusion and total replacement of the ankle: part 1: Range of motion. Foot Ankle Int 24:881–887PubMedGoogle Scholar
  12. 12.
    Cenni F, Leardini A, Cheli A et al (2011) Position of the prosthesis components in total ankle replacement and the effect on motion at the replaced joint. Int Orthop. doi: 10.1007/s00264-011-1323-6
  13. 13.
    Abdo R, Wasilewski SA (1992) Ankle arthrodesis: a long -term study. Foot Ankle Int 13:307–312Google Scholar
  14. 14.
    Crevoisier X (2009) Ankle arthritis. In: Bentley G (ed), European instructional course lectures, vol. 9, pp 227–236Google Scholar
  15. 15.
    Thordarson D (2004) Fusion in posttraumatic foot and ankle reconstruction. J Am Acad Orthop Surg 12:322–333PubMedGoogle Scholar
  16. 16.
    Naal FD, Impellizzeri FM, Loibl M et al (2009) Habitual physical activity and sports participation after total ankle arthroplasty. Am J Sports Med 37:95–102PubMedCrossRefGoogle Scholar
  17. 17.
    Healy WL, Iorio R, Lemos MJ (2000) Athletic activity after total knee arthroplasty. Clin Orthop Relat Res: 65–71Google Scholar
  18. 18.
    Healy WL, Iorio R, Lemos MJ (2001) Athletic activity after joint replacement. Am J Sports Med 29:377–388PubMedGoogle Scholar
  19. 19.
    Naal FD, Fischer M, Preuss A et al (2007) Return to sports and recreational activity after unicompartmental knee arthroplasty. Am J Sports Med 35:1688–1695PubMedCrossRefGoogle Scholar
  20. 20.
    Naal FD, Maffiuletti NA, Munzinger U, Hersche O (2007) Sports after hip resurfacing arthroplasty. Am J Sports Med 35:705–711PubMedCrossRefGoogle Scholar
  21. 21.
    Salzmann GM, Ahrens P, Naal FD et al (2009) Sporting activity after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis. Am J Sports Med 37:312–318PubMedCrossRefGoogle Scholar
  22. 22.
    Banerjee M, Bouillon B, Banerjee C et al (2010) Sports activity after total hip resurfacing. Am J Sports Med 38:1229–1236PubMedCrossRefGoogle Scholar
  23. 23.
    Wylde V, Blom A, Dieppe P et al (2008) Return to sport after joint replacement. J Bone Joint Surg Br 90:920–923PubMedCrossRefGoogle Scholar
  24. 24.
    Naal FD, Impellizzeri FM (2010) How active are patients undergoing total joint arthroplasty?: a systematic review. Clin Orthop Relat Res 468:1891–1904PubMedCrossRefGoogle Scholar
  25. 25.
    Fisher N, Killampalli VV, Kundra RK, Jagodzinski NA, Mathur K, Reading AD (2011) Sporting and physical activity following hip resurfacing. Int Orthop 35:977–980PubMedCrossRefGoogle Scholar
  26. 26.
    Halasi T, Kynsburg A, Tállay A, Berkes I (2004) Development of a new activity score for the evaluation of ankle instability. Am J Sports Med 32:899–908PubMedCrossRefGoogle Scholar
  27. 27.
    Tegner Y, Lysholm J (1985) Rating system in the evaluation of knee ligament injuries. Clin Orthop 198:43–49PubMedGoogle Scholar
  28. 28.
    Krips R, van Dijk CN, Lehtonen H, Halasi T, Moyen B, Karlsson J (2002) Sports activity level after surgical treatment of chronic anterolateral ankle instability. Am J Sports Med 30:13–19PubMedGoogle Scholar
  29. 29.
    Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC (1998) Assessing activity in joint replacement patients. J Arthroplasty 13:890–895PubMedCrossRefGoogle Scholar
  30. 30.
    Kitaoka HB, Alexander IJ, Adelaar RS et al (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353PubMedGoogle Scholar
  31. 31.
    Gougoulias N, Khanna A, Maffulli N (2010) How successful are current ankle replacements?: a systematic review of the literature. Clin Orthop Relat Res 468:199–208PubMedCrossRefGoogle Scholar
  32. 32.
    Valderrabano V, Hintermann B, Nigg BM et al (2003) Kinematic changes after fusion and total replacement of the ankle: part 3: Talar movement. Foot Ankle Int 24:897–900PubMedGoogle Scholar
  33. 33.
    Thomas R, Daniels TR, Parker K (2006) Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis. J Bone Joint Surg Am 88-A:526–535CrossRefGoogle Scholar
  34. 34.
    Bonnin M, Laurent JR, Casillas M (2009) Ankle function and sports activity after total ankle replacement. Foot Ankle Int 30:933–944PubMedCrossRefGoogle Scholar
  35. 35.
    Buchner MS (2003) Ankle fusion attributable to posttraumatic arthrosis: a long-term followup of 48 patients. Clin Orthop Relat Res 406:155–164Google Scholar
  36. 36.
    Kennedy JG, Hodgkins CW, Brodsky A, Bohne WH (2006) Outcomes after standardized screw fixation technique of ankle arthrodesis. Clin Orthop Relat Res 447:112–118PubMedCrossRefGoogle Scholar
  37. 37.
    Valderrabano V, Pagenstert G, Horisberger M et al (2006) Sports and recreation activity of ankle arthritis patients before and after total ankle replacement. Am J Sports Med 34:993–999PubMedCrossRefGoogle Scholar
  38. 38.
    Wood PL, Deankin S (2003) Total ankle replacement. The results in 200 ankles. J Bone Joint Surg Br 85:334–341PubMedCrossRefGoogle Scholar
  39. 39.
    Healy WL, Sharma S, Schwartz B, Iorio R (2008) Athletic activity after total joint arthroplasty. J Bone Joint Surg Am 90:2245–2252PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Reinhard Schuh
    • 1
    Email author
  • Jochen Hofstaetter
    • 1
  • Martin Krismer
    • 2
  • Roberto Bevoni
    • 3
  • Reinhard Windhager
    • 1
  • Hans-Joerg Trnka
    • 4
  1. 1.Department of OrthopaedicsMedical University of ViennaViennaAustria
  2. 2.Department of Orthopaedic SurgeryInnsbruck Medical UniversityInnsbruckAustria
  3. 3.Department of Orthopaedics Istituto Ortopedico RizzoliBologna Italy
  4. 4.Foot and Ankle Center ViennaViennaAustria

Personalised recommendations