Simultaneous Bilateral Total Ankle Replacement

Some patients may present degenerative changes on both ankles concurrently. In such patients, an appropriate treatment may be bilateral total ankle replacement (TAR).

There is limited information in the current literature about the outcome of simultaneous bilateral TAR. Karantana et al published a case series including five consecutive simultaneous bilateral TARs performed  between 2002 and 2006 using the STAR prosthesis. The mean follow-up in this patient cohort was 46 months, with a range between 26 and 65 months. Two patients had delayed wound healing. In one patient, a stress fracture of medial malleolus was seen 10 weeks postoperatively and treated nonoperatively in an Aircast splint for 6 weeks. At the latest follow-up, all patients experienced significant pain relief and presented with good functional outcome and reported excellent satisfaction relating to their experience.

Barg et al recently compared pain relief, quality of life, and functional outcome of 23 simultaneous bilateral TARs with that of 46 matched unilateral TARs. After 4 months, patients with simultaneous bilateral TAR had a higher pain level and worse functional outcome and quality of life as assessed by using AOFAS and SF-36 scores, respectively. However, the observed differences disappeared at the 1- and 2-year follow-up.

In summary, the two available clinical studies suggest that simultaneous bilateral TAR under one anesthetic can be offered to patients with bilateral severe ankle OA.^2,3 However, further studies including more patients with clinical and radiographic review at longer follow-up should be performed to prove the safety and efficacy of this procedure.

References

1. Valderrabano,V., Horisberger,M., Russell,I., Dougall,H., and Hintermann,B.: Etiology of ankle osteoarthritis. Clin Orthop Relat Res, 467:1800-1806, 2009.
2. Karantana,A., Martin,G.J., Shandil,M., and Dhar,S.: Simultaneous bilateral total ankle replacement using the S.T.A.R.: a case series. Foot Ankle Int, 31:86-89, 2010.
3. Barg,A., Knupp,M., and Hintermann,B.: Simultaneous bilateral versus unilateral total ankle replacement: A patient-based comparison of pain relief, quality of life and functional outcome. J Bone Joint Surg Br, 92:1659-1663, 2010.