Ankle Replacement against Ankle Arthrodesis (Fusion) Clinical Study TARVA

What is it about?

Total ankle replacement (TAR) or ankle arthrodesis (fusion) is the main surgical treatments for end-stage ankle osteoarthritis (OA). The popularity of ankle replacement is increasing while ankle fusion rates remain static. Both treatments have efficacy but to date all studies comparing the 2 have been observational without randomisation, and there are no published guidelines as to the most appropriate management. The TAR versus arthrodesis (TARVA) trial aims to compare the clinical and cost-effectiveness of TAR against ankle arthrodesis in the treatment of end-stage ankle OA in patients aged 50–85 years.

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Why is it important?

To date all studies comparing ankle replacement versus fusion have been observational and lacking randomisation and there are no published guidelines as to the most appropriate management. A meta-analysis of the literature by Haddad et al4 showed that TAR and fusion have similar intermediate term outcomes in terms of clinical scores, patient satisfaction and revision rate. Both have been shown to improve quality of life at 1 year but with no difference between the two operations.5 Another study showed a higher risk of major revision surgery with ankle replacement, but higher risk of adjacent-joint fusion with ankle arthrodesis.6 This was a population-based study and patients who received TAR and fusion may not have been comparable. The TAR versus arthrodesis (TARVA) trial aims to investigate the clinical and cost-effectiveness and complication rates of TAR against ankle arthrodesis in the treatment of end-stage ankle OA in patients aged 50–85 years.

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