Comparing Ankle Fusion to Ankle Replacement

Comparing Ankle Arthrodesis to Ankle Arthroplasty

End-stage ankle arthritis (ESAA) is a debilitating condition associated with severe pain, dysfunction, and reduced quality of life. Many patients with ESAA have difficulty walking for even 100 feet or up a single flight of stairs. Patients seeking surgery for ESAA have two primary treatment options: ankle arthrodesis (i.e., ankle fusion) and ankle arthroplasty (i.e., ankle replacement). Few studies have directly compared the effectiveness of these two procedures, and no randomized controlled trials (RCTs) have been performed.

The investigators will compare the following in subjects undergoing ankle arthrodesis and ankle arthroplasty before surgery, and post-surgery at 3 and 6 months, and on an annual basis up to ten years.

1. Overall physical function and ankle specific function
2. Ankle pain intensity and interference with activities
3. Activity levels
4. Overall general health
5. Post-surgical complication rates

The investigators will also identify prognostic factors that are predictive of higher physical function, ankle specific function, reduced pain, improved general health, and overall patient satisfaction.

Study Overview

• Status: Completed
• Conditions: Osteoarthritis (OA); End-stage Ankle Arthritis (ESAA)
• Intervention / Treatment: Procedure: Ankle Arthrodesis; Procedure: Ankle Arthroplasty

Detailed Description

From study inception until March 2014, the investigators conducted a multi-site randomized controlled trial (RCT) comparing the effectiveness of ankle arthrodesis and ankle arthroplasty over a 2-year follow-up period. The study used a modified Comprehensive Cohort Design. Subjects unwilling to randomize to surgery could still participate in the study by entering into the preference cohort and select surgery in consultation with their surgeon.

By March 2014, no subjects had entered into the randomized cohort. The Data and Safety Monitoring Board (DSMB) recommended stopping recruitment in the randomized arm of the study since no subjects were willing to randomize to surgery. All patients were enrolled in the preference cohort and selected arthrodesis or arthroplasty. Despite the change in study design, the objectives remain unchanged.

• Study Type: Observational
• Enrollment (Actual): 517

Contacts and Locations

Study Locations

• United States
  • Colorado
    • Fort Collins, Colorado, United States, 80525
      • Orthopaedic and Spine Center of the Rockies
  • Michigan
    • Grand Rapids, Michigan, United States, 49525
      • Orthopaedic Associates of Michigan
  • Minnesota
    • Edina, Minnesota, United States, 55435
      • Twin Cities Orthopedics
  • Oregon
    • Portland, Oregon, United States, 97225
      • Orthopedic + Fracture Specialists
  • Washington
    • Seattle, Washington, United States, 98104
      • Harborview Medical Center
    • Seattle, Washington, United States, 98108
      • VA Puget Sound Health Care System

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years to 89 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Subjects are recruited from surgical foot and ankle orthopedic clinics at the participating study sites.

Description

Inclusion Criteria:

1. Diagnosis of ankle arthritis
2. Failed conservative care and deemed a surgical candidate
3. Adult patients between 21 and 89 years of age
4. Ambulatory but whose primary impediment to pain-free ambulation is ankle arthritis

Exclusion Criteria:

1. Recent surgical, neurological, metabolic, or lower limb musculoskeletal problem that might impair the ambulation measures in the study such as severe knee or hip osteoarthritis
2. Complicated procedures requiring multiple corrections
3. Inflammatory arthritis with multi-focal disease (i.e. arthritis that affects multiple parts of the body)
4. Inadequate cognitive or language function to consent to participate
5. Unable or unwilling to participate in clinic follow-ups and/or remote follow-ups for 24 months after surgery
6. Unwilling or unable to comply with postoperative management program
7. Lack of a telephone number or stable mailing address

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Preference, Ankle Arthrodesis	Procedure: Ankle Arthrodesis; All surgeons will employ a well-established technique of rigid internal fixation. In this technique, the joint is prepared by removing cartilage from the surfaces, the bones are positioned as desired, and screws and/or a plate are attached to compress the bones together and prevent motion. This technique obviates the need for a cast or external support. Patients are allowed to walk with weight bearing aids immediately. Radiographs are performed at 6 weeks to determine weight bearing status. Weight is allowed on the limb in increments over the 6 to 12 weeks after surgery.; Other Names: Ankle Fusion
Preference, Ankle Arthroplasty	Procedure: Ankle Arthroplasty; Protocols are similar among participating centers. Each surgeon uses an anterior surgical approach between the tibialis anterior tendon and the toe extensor group, splints the ankles for 2 weeks, and restricts weight bearing for the first 6 weeks. Radiographs are performed at 6 weeks to determine weight bearing status. The study involves only FDA approved implants with which the surgeon has established experience.; Other Names: Total Ankle Replacement

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) Score Between Subjects Undergoing Ankle Arthrodesis and Total Ankle Arthroplasty	Ankle specific function was assessed using the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) subscale, a validated, self-reported questionnaire which measures functional ability during activities of daily living. [CH1.1]The FAAM ADL subscale sums and coverts responses to a standardized score ranging from 0 to 100%. A score of 0% represents complete disability, and a score of 100% represents no functional limitations. Higher scores indicate better ankle function.	Before surgery, 1 year post-op, 2 years post-op, 4 years post-op, and 8 years post-op
Change in Foot and Ankle Ability Measure (FAAM) Sports Subscale Between Subjects Undergoing Ankle Arthrodesis and Total Ankle Arthroplasty	Ankle specific function during sports activities was measured using the Foot and Ankle Ability Measure (FAAM) Sports subscale, a validated, self-reported questionnaire which measures functional ability during sport-related activities. The FAAM Sports subscale sums and converts responses to a standardized score ranging from 0 to 100%. A score of 0% represents complete disability, and a score of 100% represents no functional limitations. Higher scores indicate better ankle function during sports activities.	Before surgery, 1 year post-op, 2 years post-op, 4 years post-op, and 8 years post-op
Change in Short Form-36 (SF-36) Physical Component Summary (PCS) Score Between Subjects Undergoing Ankle Arthrodesis and Total Ankle Arthroplasty	Ankle specific function was assessed using the Short Form-36 (SF-36) Physical Component Summary (PCS) score, a validated, generic measure of health-related quality of life that evaluates physical health status. The PCS score is derived from responses to the SF-36 questionnaire and is norm-based, with scores ranging from 0-100, where higher scores indicate better physical health and lower scores indicate poorer physical health.	Before surgery, 1 year post-op, 2 years post-op, 4 years post-op, and 8 years post-op
Change in Overall Pain Intensity and Ankle Specific Pain Intensity; Interference With Activities in Subjects Undergoing Ankle Arthrodesis and Total Ankle Arthroplasty (Worst Pain)	Pain was assessed using two questions from the Chronic Pain Grade (CPG), including intensity of worst pain in past 6 months. This was scored on a 0-10 point scale where higher scores represented greater pain (e.g., 0 = "no pain" and 10 = "pain as bad as it could be")	Before surgery, 1 year post-op, 2 years post-op, 4 years post-op, and 8 years post-op
Change in Overall Pain Intensity and Ankle Specific Pain Intensity; Interference With Activities in Subjects Undergoing Ankle Arthrodesis and Total Ankle Arthroplasty (Average Pain)	Pain was assessed using two questions from the Chronic Pain Grade (CPG), including intensity of average ankle pain in past 6 months. This was scored on a 0-10 point scale where higher scores represented greater pain (e.g., 0 = "no pain" and 10 = "pain as bad as it could be")	Before surgery, 1 year post-op, 2 years post-op, 4 years post-op, and 8 years post-op

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-surgical Complication Rates	Ankle-specific complications in the 12-month period post surgery	Assessed monthly until 12 months after surgery
Change in Daily Step Counts	Step counts using a StepWatch Activity Monitor, worn for a 7-14 day time period.	Before surgery and at 6, 12, and 24 months after surgery

Collaborators and Investigators

• Sponsor: Seattle Institute for Biomedical and Clinical Research
• Collaborators: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institutes of Health (NIH); University of Washington; Orthopaedic Associates of Michigan, PC; Orthopedic + Fracture Specialists, Portland, OR; Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics; Orthopaedic and Spine Center of the Rockies
• Investigators: Principal Investigator: Bruce J Sangeorzan, MD, VA Puget Sound Health Care System & University of Washington

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2012
• Primary Completion (Actual): April 1, 2026
• Study Completion (Actual): April 1, 2026

Study Registration Dates

• First Submitted: June 11, 2012
• First Submitted That Met QC Criteria: June 13, 2012
• First Posted (Estimated): June 15, 2012

Study Record Updates

• Last Update Posted (Actual): August 21, 2026
• Last Update Submitted That Met QC Criteria: August 19, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Arthritis; Joint Diseases; Rheumatic Diseases; Osteoarthritis; Surgical Procedures, Operative; Arthroplasty, Replacement; Arthroplasty; Orthopedic Procedures; Plastic Surgery Procedures; Prosthesis Implantation; Arthroplasty, Replacement, Ankle
• Other Study ID Numbers: SB223; 1R01AR056316-01A2 (U.S. NIH Grant/Contract)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No