Analysis of early failure rate and its risk factor with 2157 total ankle replacements

Lee, Jung Woo; Im, Wooyoung; Song, Si Young; Kim, Sung Jae

doi:10.1038/s41598-021-81576-y

Cited by 15 publications

(7 citation statements)

References 48 publications

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“…6 More recent studies of 5-year TAR outcomes have reported reoperation rates ranging from 9.1% to 23%. 15,18,[30][31][32] Taken together, data from the current study suggest improved TAR survival to revision and explant surgery in recent years. This finding further supports improved outcomes following TAR as a driver of minimal increases in annual TAR revisions with respect to the rapidly increasing number of TAR procedures performed each year.…”

Section: Discussionmentioning

confidence: 72%

The Burden of Revision Total Ankle Replacement Has Increased From 2010 to 2020

Ratnasamy,

Maloy,

Oghenesume

et al. 2023

Foot & Ankle Orthopaedics

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Background: Total ankle replacement (TAR) surgery has increased in recent decades. The aim of this study was to investigate the evolving burden of revision surgery and risk factors and timing of revision or explant. Methods: Using the 2010 to 2020 PearlDiver M151Ortho data set, this retrospective cohort study identified primary TAR, TAR revision, and TAR explant patients via Current Procedural Terminology ( CPT) and International Classification of Disease Procedural ( ICD-P) codes. This database contains billing claims information across all payers and sites of care in the United States. Patient factors investigated included age, sex, and Elixhauser Comorbidity Index (ECI). Annual incidence for primary TAR was normalized per 100 000 covered lives in the data set for each year of study and recorded. Annual incidence of revision TAR and explant were normalized per 100 TARs performed for each year of study. Multivariate logistic regression analyses were performed to determine independent risk factors for revision TAR or explant. For explants, the eventual intervention by 2 years was analyzed. Ten-year timing and survival to revision or explant surgery following unilateral TAR were characterized. Results: A total of 10 531 primary, 1218 revision, and 1735 explant TARs were identified. After normalization, TAR utilization increased by 284% from 2010 to 2020, annual TAR revisions rose 28%, and annual TAR explants decreased 65%. Independent predictors of revision TAR were younger age (odds ratio [OR] 1.29 per decade decrease) and higher ECI (OR 1.23 per 2-point increase). Independent predictors of explant included younger age (OR 1.80 per decade decrease), female sex (OR 1.17), and higher ECI (OR 1.35 per 2-point increase). The 10-year implant survival rate was 91.8%, of which 73% of revisions and 83% of explants occurred in the first 3 years following index TAR. Conclusion: TAR utilization has grown substantially over the past decade, with minimal increases in the annual rate of revision surgery with respect to index procedures performed. Level of Evidence: Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 72%

The Burden of Revision Total Ankle Replacement Has Increased From 2010 to 2020

Ratnasamy,

Maloy,

Oghenesume

et al. 2023

Foot & Ankle Orthopaedics

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“… 22 A more recent national (Republic of Korea) database review of 2157 primary TAA also revealed diabetes mellitus, along with chronic pulmonary disease, to be associated with early failure in TAA. 17 In contrast, patients with diabetes and ankle arthritis who underwent TAA at a single institution had similar clinical outcomes compared with their nondiabetic counterparts. 14 Although patients with diabetes had increased body mass index, and worse ASA preoperative grades, they did not have a significantly different complication or infection rate.…”

Section: Discussionmentioning

confidence: 95%

Factors Predictive of Early Complications Following Total Ankle Arthroplasty

Balso

Halai

MacLeod

et al. 2022

Foot & Ankle Orthopaedics

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Background: The safety of outpatient total ankle arthroplasty (TAA), and factors predictive of early complications are poorly understood. The objective of this study was to determine the frequency of early complications in patients undergoing outpatient TAA compared to a matched inpatient TAA cohort. Factors predictive of early complications following TAA are elucidated. Methods: A retrospective review of prospectively collected data from the 2011-2018 American College of Surgeons–National Surgical Quality Improvement Program (ACS-NSQIP) database was performed. An unadjusted analysis comparing complication rates in outpatient, and inpatient TAA was performed followed by a propensity score–matched cohort analysis. A multivariate logistic regression model was then used to identify significant independent predictors for complications, reoperation, and readmission following TAA. Results: A total of 1487 patients (198 outpatient, 1289 inpatient) undergoing TAA were included in the study. Inpatient TAA was associated with increased 30-day readmission compared with outpatient TAA (3.54% vs 0.51%, P = .032) in a matched cohort analysis. Thirty-eight (2.6%) patients had a minor complication, with 16 (1.1%) patients having a major complication after TAR. Nineteen (1.3%) patients underwent reoperation, and 42 (2.8%) patients were readmitted within 30 days of the index TAR. Multivariate analysis identified factors predictive of early complications to include length of stay (LOS) >2 days, smoking, hypertension, bleeding disorders, and diabetes mellitus. Conclusion: From this relatively limited data set, outpatient TAA appears to be safe for management of end-stage ankle arthritis in select patients. Inpatient status was associated with an increased rate of 30-day readmission following TAA. Postoperative length of stay >2 days, smoking, hypertension, bleeding disorders, and diabetes mellitus were identified to be associated with early postoperative complications following TAA in this cohort. Level of Evidence Level III, retrospective cohort study.

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“…12,21,54 However, the role of excess weight or obesity as a prognostic factor for TAA is still under debate. 20,31,33,37…”

Section: Introductionmentioning

confidence: 99%

“…12,21,54 However, the role of excess weight or obesity as a prognostic factor for TAA is still under debate. 20,31,33,37 In orthopaedic clinical practice, body weight is a crucial criterion in patient selection since the negative effect of higher body mass index (BMI) on hip and knee arthroplasty outcomes is proven. 27,41,42 Furthermore, the arterial collateral capacity and the soft tissue coverage decrease toward the end of the lower limb.…”

Section: Introductionmentioning

confidence: 99%

Obesity and Ankle Prosthesis Revision: A Systematic Review and Meta-analysis

Varga,

Váncsa,

Agócs

et al. 2023

Foot Ankle Int.

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Background: The increasing number of total ankle arthroplasties (TAAs) has led to growing evidence on the risk factors for complications after surgery. However, the role of obesity in this patient group has been the subject of much debate. Therefore, this systematic review aimed to investigate the evidence for untoward effects of obesity following TAA. Methods: We conducted a comprehensive search on April 28, 2023, in MEDLINE (via PubMed), Embase, and CENTRAL. Eligible observational studies reported on the short- and long-term outcomes of primary TAA, comparing patients with and without obesity (defined as body mass index > 30). Using a random effects model, we calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) from 2 by 2 tables (event and nonevent in the obese and nonobese primary TAA groups). Results: Nine studies with 10 388 patients were eligible for inclusion in the meta-analysis. We found significantly higher odds of revision in the obese group compared to the nonobese group (OR = 1.68, CI: 1.44-1.95). However, the odds of overall perioperative complications (OR = 1.55, CI: 0.50-4.80) and wound complications (OR = 1.34, CI: 0.29-6.20) were nonsignificantly higher in the obese group. Conclusion: Based on our results, obesity may have affected long-term outcomes following TAA and may have negatively affected the prosthesis’s survival.

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Analysis of early failure rate and its risk factor with 2157 total ankle replacements

Cited by 15 publications

References 48 publications

The Burden of Revision Total Ankle Replacement Has Increased From 2010 to 2020

The Burden of Revision Total Ankle Replacement Has Increased From 2010 to 2020

Factors Predictive of Early Complications Following Total Ankle Arthroplasty

Obesity and Ankle Prosthesis Revision: A Systematic Review and Meta-analysis

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