Experiences of Living with Bilateral Total Ankle Replacement and Ankle Arthrodesis: A Qualitative Study from a Patient Perspective

Abstract

Category:Ankle ArthritisIntroduction/Purpose:Total ankle replacement (TAR) and ankle arthrodesis are both effective treatments for end-stage ankle arthritis, however differences in treatment outcomes may be better understood using a qualitative inquiry among individuals who have undergone both procedures. The purpose of this study was to investigate patients’ experiences and impressions of living with bilateral TAR and ankle arthrodesis.Methods:The sample consisted of 10 patients, selected purposively from a larger cohort, who could speak English and had a TAR on one side and ankle arthrodesis on the contralateral side. All procedures were completed by a single experienced surgeon.Semi-structured interviews were conducted at least one year after completion of the most recent procedure (TAR or arthrodesis). Qualitative data analysis was performed in accordance with a descriptive phenomenological theoretical approach, from which codes and themes were derived.Results:Interviews revealed advantages and disadvantages associated with both TAR and ankle arthrodesis from the patients’ perspective. Two overarching domains in which differences between their TARs and ankle fusions emerged: psychological and musculoskeletal. Within these domains, concepts of vigilance (as previously described by Pinsker) and strategizing the use of one ankle over the other emerged as themes that unified nearly all patients. Specific differences between the two procedures with respect to stability versus flexibility were commonly identified. Overall, patients preferred their TAR.Conclusion:This study provides insight into the lived experiences of a unique group of patients who have both an ankle arthrodesis and TAR. Patients evaluated the impact of TAR and ankle arthrodesis on their lives and overwhelmingly favoured TAR. The findings of this study can help clinicians to better counsel patients on expectations after TAR and ankle arthrodesis, and may aid researchers improve patient-report measurement instruments to better capture the outcomes that are important to patients.