A Prospective Cohort Study Comparing Functional Outcomes of Primary and Revision Ankle Replacements

Jennison, Toby; King, Andrew; Hutton, Christopher Ej; Sharpe, IT

doi:10.1177/10711007211010188

Cited by 9 publications

(9 citation statements)

References 27 publications

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“…17,18 As surgical techniques and implant design continually improve, so has implant survivorship, with recent midterm studies demonstrating survival rates ranging from 80% to 98%. 13,15,25,40 Early results from modern implants have demonstrated that TAA is equivalent to arthrodesis in terms of relieving pain, but result in improved functional outcomes, 20,41 with a systematic review suggesting that TAA is associated with fewer complications and higher reoperation rates. 29 In addition, a previous report has demonstrated that TAA offers advantages of preserving range of motion and allowing for gait patterns that are more physiologic compared to patients with an ankle arthrodesis.…”

Section: Introductionmentioning

confidence: 99%

Midterm Survivorship of the INBONE II Total Ankle Arthroplasty

et al. 2021

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Background: The use of total ankle arthroplasty (TAA) in the treatment of ankle arthritis has grown substantially as advancements are made in design and surgical technique. Among the criteria guiding the choice between arthroplasty and arthrodesis, the long-term survival and postoperative outcomes are of crucial importance. Although outcomes of the INBONE I have been published, there is limited midterm survival data for the INBONE II. The purpose of this study was to determine the radiographic and patient-reported outcomes, and survivorship of this prosthesis in patients with a minimum 5-year follow-up. Methods: We retrospectively identified 51 ankles (46 patients) from 2010 to 2015 who underwent TAA with the INBONE II prosthesis at our institution. Of these, 44 cases had minimum clinical follow-up of 5 years (mean, 6.4; range 5-9). Median age was 66 years (range 42-81) and median BMI was 27.5 (range 20.1-33.0). A chart review was performed to record the incidence of revision and reoperation. Preoperative and postoperative radiographs were analyzed to assess the coronal tibiotalar alignment (TTA), the talar inclination angle, and the presence of periprosthetic lucencies and cyst formation. Preoperative and minimum 5-year postoperative Foot and Ankle Outcome Score (FAOS) subscales were compared. Survivorship was determined by incidence of revision, defined as removal of a metallic component. Results: The survivorship at 5 years was 98% and the rate of reoperation was 7.8% (n = 4); 2 patients underwent irrigation and debridement for infection, 1 patient underwent a medializing calcaneal osteotomy, and 1 patient underwent open gutter debridement, 1 patient underwent a revision of a subsided talar component at 3.2 years after index surgery. Average postoperative TTA was 88.6 degrees, with 42 rated as neutral (85-95 degrees), 2 varus (<85 degrees), and no valgus (>95 degrees) ankles. At final follow-up, asymptomatic periprosthetic cysts were observed in 8 patients. All FAOS domain scores improved between preoperative and final follow-up. Conclusion: At midterm follow-up, we observed significant improvement in radiographic alignment and patient-reported outcome scores for the INBONE II total ankle prosthesis. In addition, this cohort has had a relatively low reoperation rate and high survivorship. Level of Evidence: Level IV, case series.

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Section: Introductionmentioning

confidence: 99%

Midterm Survivorship of the INBONE II Total Ankle Arthroplasty

et al. 2021

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“…for primary TAAs compared with 20.2 for revision TAAs, which was a statistically significant difference. 9 In the revision TAA cohort, the 6 patients who underwent a 2-stage septic revision arthroplasty had, on average, less improvement in their MOxFQ scores than those patients who underwent an aseptic revision although this did not reach statistical significance. 9 Sangeorzan et al recently demonstrated statistical and clinical improvement in patient-reported outcomes following primary TAA and ankle arthrodesis using the FAAM ADL and Sports subscales.…”

Section: Discussionmentioning

confidence: 87%

“…25 Recent studies have demonstrated that improvements in patient-reported outcomes following a revision TAA are significantly lower than those following a primary TAA. 9 Jennison et al reported that the mean overall change in the Manchester Oxford Foot Questionnaire (MOxFQ) was 48.8…”

Section: Discussionmentioning

confidence: 99%

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Complications, Reoperations, and Patient-Reported Outcomes Following a 2-Stage Revision Total Ankle Arthroplasty for Chronic Periprosthetic Joint Infections

et al. 2022

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Background: As total ankle arthroplasty (TAA) becomes more common, chronic periprosthetic joint infections (PJIs) will be encountered more frequently. No studies have reported on patient-reported outcomes following a 2-stage revision procedure for a chronic PJI after a TAA. The primary purpose of this study was to investigate postoperative clinical outcomes at a minimum of 2 years following a 2-stage revision TAA for chronic PJI. Methods: Patients who underwent a 2-stage revision TAA for a chronic PJI (>4 weeks after a primary TAA) between January 2010 and December 2019 were eligible to be included in this study. Chronic PJI was defined as a sinus tract that directly communicated with the prosthesis or the same organism identified in ≥2 synovial fluid samples. Twelve patients were eligible to be included in this case series. One patient died prior to 2-year follow-up, which left 11 patients available for analysis. All 11 patients underwent reimplantation. The data were found not to be normally distributed; therefore, medians and interquartile ranges (IQRs) were reported. Results: At a median of 3.0 years (IQR 2.0-4.0 years) following the second stage of their revision arthroplasty, the median Foot and Ankle Ability Measure (FAAM) Activities of Daily Living and Sports scores were 60.7 (IQR 52.4, 79.8) and 31.3 (IQR 9.4, 40.6), respectively. At final follow-up, 10 patients (90.9%) were ambulating with a TAA in place. Seven patients (63.6%) required a reoperation including 1 patient who underwent a below-knee amputation. Conclusion: Our study suggests that a 2-stage revision TAA may be an option for patients with a chronic PJI. However, patients who undergo a 2-stage revision TAA for a chronic PJI have lower than previously published 2-year FAAM scores and a high rate of reoperation. Level of Evidence: Level IV, case series.

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“… 41 The Swedish Arthroplasty Registry reports a mean SEFAS score of 22 after revision ankle arthroplasty compared to 31 after primary arthroplasties, and this was also found by Lachman et al 6 across all scores. 41 , 43 The only study that directly compares functional scores between revision arthroplasty and conversion to fusion demonstrates similar functional scores for both techniques. 5 , 8 A greater proportion of outcome scores were significantly improved with revision ankle arthroplasty than conversion to fusion, but due to small numbers it was impossible to calculate if this was statistically significant.…”

Section: Discussionmentioning

confidence: 99%

The outcomes of revision surgery for a failed ankle arthroplasty

et al. 2022

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Aims Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations. Methods A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed. Results Six papers analyzed all-cause reoperations of revision ankle arthroplasties, and 14 papers analyzed failures of conversion of a TAA to fusion. It was found that 26.9% (95% confidence interval (CI) 15.4% to 40.1%) of revision ankle arthroplasties required further surgical intervention and 13.0% (95% CI 4.9% to 23.4%) of conversion to fusions; 14.4% (95% CI 8.4% to 21.4%) of revision ankle arthroplasties failed and 8% (95% CI 4% to 13%) of conversion to fusions failed. Conclusion Revision of primary TAA can be an effective procedure with improved functional outcomes, but has considerable risks of failure and reoperation, especially in those with periprosthetic joint infection. In those who undergo conversion of TAA to fusion, there are high rates of nonunion. Further comparative studies are required to compare both operative techniques. Cite this article: Bone Jt Open 2022;3(7):596–606.

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A Prospective Cohort Study Comparing Functional Outcomes of Primary and Revision Ankle Replacements

Cited by 9 publications

References 27 publications

Midterm Survivorship of the INBONE II Total Ankle Arthroplasty

Midterm Survivorship of the INBONE II Total Ankle Arthroplasty

Complications, Reoperations, and Patient-Reported Outcomes Following a 2-Stage Revision Total Ankle Arthroplasty for Chronic Periprosthetic Joint Infections

The outcomes of revision surgery for a failed ankle arthroplasty

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