What is the best form of osteoarthritis treatment? 

What is the best form of osteoarthritis treatment?

A new study has shown that patients with ankle osteoarthritis who undergo surgery see equally good outcomes from the two main forms of surgical osteoarthritis treatment. 

A randomised clinical trial, led by the Comprehensive Clinical Trials Unit at University College London, has compared total ankle joint replacement against ankle fusion. The researchers analysed the outcomes of 280 patients aged between 50 and 85. Half the patients had total ankle replacement and half had ankle fusion surgery. Both forms of osteoarthritis treatment are designed to relieve pain and restore movement in the ankle.  

The full study has been published in the journal Annals of Internal Medicine.   

Both procedures had positive outcomes

The outcomes were measured by assessing quality of life, pain levels and ability to carry out daily activities after each respective osteoarthritis treatment. Patients were assessed before their operation and twelve months after the procedure.  

The researchers found that both total procedures considerably improved patients’ quality of life. The research team found no significant statistical differences between each operation. However, when the ankle replacement procedure was examined in isolation, the researchers observed significant improvement in clinical scores and quality of life over ankle fusion.  

The findings also show that total joint replacement saw better clinical outcomes than ankle fusion in patients with arthritis in surrounding joints. During ankle fusion, the shin bone is pinned to the talus, the uppermost bone in the foot. This inhibits movement in the ankle joint but allows movement in 30 other joints in the foot.   

Each patient underwent an MRI scan before their operation, 42% were found to have arthritis in surrounding joints, however, many of them had no symptoms. In the follow-up analysis, patients who underwent joint replacement were found to have a better range of movement than those that underwent ankle fusion. 

“This study shows how important it is to know the health of the surrounding joints before the patient undergoes surgery, which may involve an MRI, as it could help inform which procedure might be better for the patient,” explained Andrew Goldberg, the consultant orthopaedic surgeon who led the trial.  

The pros and cons of each osteoarthritis treatment

The researchers highlighted differences in complications following the two types of osteoarthritis treatment. The wounds of those who underwent total ankle replacement took longer to heal than those who received an ankle fusion. Patients who underwent total ankle replacement were also more likely to experience nerve damage after surgery. 

On the other hand, ankle fusion patients were more likely to suffer from blood clots in their legs after the procedure. This is because the surgery requires patients to be immobilised for a long time.  

“Although the risks are not life-threatening, understanding the different risks involved in each procedure is essential. Our aim in this trial was to provide the data that patients need to make informed decisions about these operations. We’ve clearly shown that both joint replacement and fusion provide significant patient benefits. We also found that the type of joint replacement seems to have an effect, but this needs further research,” said Golberg.  

 “This is the largest study of its kind to be completed in this field, providing robust findings thanks to the teams across the UK who contributed and ensured high data quality,” concluded Kashfia Chowdhury, corresponding author of the study. 


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