Survey of Current Articles Published on Total Ankle Arthroplasty and Ankle Fusion

In the United States, ankle fusion is more commonly performed than total ankle arthroplasty (TAA) for treatment of degenerative joint disease of the ankle. However, recent advances in implant design and technique have led to a renewed interest in research on TAA. To shed light on current research trends and limited data rather than examine the merits between both methods, we performed a PubMed search of studies on TAA and ankle fusion between January 1, 2009, and January 1, 2015, published in both the American edition of the Journal of Bone and Joint Surgery (JBJS) and Foot & Ankle International (FAI). We chose these journals because of their combined audience of both a specific orthopaedic subspecialty and the general orthopaedic community. A total of 132 articles met our inclusion criteria, with 76% and 3% of articles on TAA alone and ankle fusion alone published in JBJS, respectively, and 61% and 19% in FAI, respectively. Additionally, we found that a relatively small number of authors accounted for 65% of the articles in JBJS and 18% in FAI. The replacement of one procedure by the other will not likely occur in the near future, but our findings indicate a current research trend toward TAA more than ankle fusion. The clinical impact of an increased amount of studies on TAA has yet to be determined. Introduction In the United States, the gold standard for treatment of advanced ankle arthritis has been ankle fusion, performed more than six times as often as total ankle arthroplasty (TAA).1 Because first-generation TAA in the 1970s had high failure rates associated with inadequate fixation of implants and soft-tissue complications, the procedure was gradually discontinued.2 For the past several years, however, advances in surgical technique and implant design have resulted in an increased success of second-generation TAA in treating select patients with painful end-stage ankle arthritis. Although comparative long-term studies are still limited, interest has been renewed in TAA.3 We conducted a review of the number of articles on TAA compared with ankle fusion published in both the American edition of the Journal of Bone and Joint Surgery (JBJS) and Foot & Ankle International (FAI) from 2009 to 2015. We searched subtopics such as treatment outcomes, complications, gait analysis, and revision operations to examine possible trends in research. We also noted individual and groups of authors who reported most often on the topic. Methods The time period was arbitrarily set to include current and recent studies on newer-generation implants used by TAA and ankle fusion, revealing probable trends in direction of research. JBJS and FAI were chosen for article extraction because, combined, the journals targeted general orthopaedic audiences and the subspecialty of foot and ankle surgery. JBJS is available to all members of the American Academy of Orthopaedic Surgeons, which includes more than 30,000 members. FAI is distributed among more than 2100 members of the American Orthopaedic Foot and Ankle Society. Articles on TAA and ankle fusion published in these journals from January 1, 2009, to January 1, 2015, were identified by searches of PubMed with Boolean modifiers of “ankle fusion,” “ankle arthrodesis,” “total ankle arthroplasty,” and “total ankle replacement.” Letters to the editor, commentaries, and author replies were not included. All articles were reviewed for inclusion by the first author and an independent review was done by the second. We selected articles that described outcomes, complications, gait analyses, and revision procedures. In addition, we tracked which group or set of authors published the most papers on these subjects in JBJS. We noted how often these authors and groups with multiple publications appeared in FAI. Results The primary search strategy for PubMed yielded 132 articles that met our inclusion criteria (Table 1). During the time period examined, a total of 29 studies on TAA and ankle fusion were published in JBJS. About 76%, 21%, and 3% of studies were on TAA alone, TAA and ankle fusion, and ankle fusion alone, respectively. In FAI, a total of 103 studies were included, with about 61%, 20%, and 19% on TAA alone, TAA and ankle fusion, and ankle fusion alone, respectively. In the JBJS articles, three multi-published authors or groups accounted for 65% of the articles. These same three authors and groups accounted for 18% of the articles reviewed in FAI.