Complications Following Total Ankle Arthroplasty Versus Ankle Arthrodesis for Primary Ankle Osteoarthritis

Ross, Bailey J.; Savage-Elliott, Ian; Wu, Victor; Rodriguez, Ramon

doi:10.1177/1938640020987741

Cited by 14 publications

(8 citation statements)

References 35 publications

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“…23 This may explain why subtalar joint OA progression is typically not observed in the majority of patients following TAR, with lower rates of adjacent joint complications. 14,35 Collectively, we view these biomechanical findings as being a favorable outcome of TAR in this patient group. We did, however, observe increased variability in the implanted tibiotalar internal/external rotation kinematics in the TAR limb, which we posit is due to the imprecision of positioning the talar implant in the axial plane for this specific Zimmer TAR implant.…”

Section: Discussionmentioning

confidence: 67%

Total Ankle Replacement Provides Symmetrical Postoperative Kinematics: A Biplane Fluoroscopy Imaging Study

et al. 2022

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Background: In vivo measurements of tibiotalar and subtalar joint motion following TAR are unavailable. Using biplane fluoroscopy, we tested the hypothesis that the prosthetic tibiotalar joint and adjacent subtalar joint would demonstrate kinematic and range of motion differences compared to the contralateral untreated limb, and control participants. Methods: Six patients of 41 identified candidates that all underwent unilateral Zimmer TAR (5.4 ± 1.9 years prior) and 6 control participants were imaged with biplane fluoroscopy during overground walking and a double heel-rise activity. Computed tomography scans were acquired; images were segmented and processed to serve as input for model-based tracking of the biplane fluoroscopy data. Measurements included tibiotalar and subtalar kinematics for the TAR, untreated contralateral, and control limbs. Statistical parametric mapping quantified differences in kinematics throughout overground walking and the double heel-rise activity. Results: Patients with this TAR performed walking and heel-rise activities symmetrically with no significant kinematic differences at the tibiotalar and subtalar joints between limbs. Compared to control participants, patients exhibited reduced dorsi/plantarflexion range of motion that corresponded to decreased peak dorsiflexion, but only in the late stance phase of walking. This reduction in tibiotalar dorsi/plantarflexion range of motion in the TAR group became more apparent with double heel-rise activity. Conclusion: Patients with a Zimmer TAR had symmetric kinematics during activities of walking and double heel-rise, but they did exhibit minor compensations in tibiotalar kinematics as compared to controls. Clinical Relevance: The lack of significant kinematic compensation at the subtalar joint may explain why secondary subtalar osteoarthritis is reported as being relatively uncommon in patients with some TAR designs.

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Section: Discussionmentioning

confidence: 67%

Total Ankle Replacement Provides Symmetrical Postoperative Kinematics: A Biplane Fluoroscopy Imaging Study

et al. 2022

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“…One challenge in comparing TAR and AA is that they have different advantages and types of complications 29 . TAR has the benefits of improved gait and protection of adjacent joints but may lead to implant loosening, polyethylene breakage, and persistent pain 3 , 4 , 6 , 8 .…”

Section: Discussionmentioning

confidence: 99%

“…We had a short follow-up of 2 years, while other studies have indicated that the revision rates of TAR are twice that of AA after 5 years 23 . Many surgical complications after TAR, such as loosening or breakage of the plastic insert, occur beyond 2 years 6 , 25 , 30 , while many complications following AA, such as wound problems, infection, and nonunion, occur within the first 2 years 29 , 31 . Additional studies with follow-up beyond 5 years are needed to advance our understanding of the benefits and limitations of TAR and AA 21 , 30 .…”

Section: Discussionmentioning

confidence: 99%

Two-Year Revision Rates in Total Ankle Replacement Versus Ankle Arthrodesis

et al. 2022

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Background:The aim of this study was to compare outcomes between total ankle replacement (TAR) and ankle arthrodesis (AA) for ankle osteoarthritis using real-world data.Methods:We used longitudinal claims data from New York State from October 2015 to December 2018, and from California from October 2015 to December 2017. The primary outcome was revision. Secondary outcomes were in-hospital complications and below-the-knee amputation. Propensity-score matching adjusted for differences in baseline characteristics. To determine predictors of the main outcome, each group was analyzed using multivariable Cox regressions.Results:There were 1,477 TAR procedures (50.2%) and 1,468 AA procedures (49.8%). Patients undergoing TAR were less likely to belong to a minority group and had fewer comorbidities compared with those undergoing AA. Crude analyses indicated that the TAR group had a lower risk of revision (5.4% versus 9.1%), in-hospital complications (<1% versus 1.8%), and below-the-knee amputation (<1% versus 4.9%) (p < 0.001 for all). However, in the propensity-score-matched analysis, the risk of revision was no longer significantly lower (TAR, 5.6% versus AA, 7.6%; p = 0.16). In the multivariable analyses, older age was predictive of a lower risk of revision after TAR (hazard ratio [HR], 0.96 [95% confidence interval (CI), 0.93 to 1.00]), but age was not predictive of revision after AA (HR, 0.99 [95% CI, 0.97 to 1.01]). Female patients were less likely to undergo revision after AA (HR, 0.61 [95% CI, 0.39 to 0.96]), but sex was not predictive of revision after TAR (HR, 0.90 [95% CI, 0.51 to 1.60]).Conclusions:The 2-year adjusted revision risk was 5.6% after TAR and 7.6% after AA. This difference did not reach significance. Older age was a predictor of lower revision risk after TAR. Men had a higher risk of revision than women after AA. The number of TAR procedures has now caught up with the number of AA procedures.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…Due to residual mobility, OA of adjacent joints should in theory occur less often after TAA than after ankle arthrodesis [11,12]. However, there is a lack of studies directly comparing OA of adjacent joints after TAA and ankle arthrodesis, such as in a prospective randomized controlled trial setting [13][14][15][16]. Additionally, different rates of OA of adjacent joints after ankle arthrodesis have been reported in the literature [41].…”

Section: Discussionmentioning

confidence: 99%

“…The intended advantages of TAA are good residual mobility and thus improved function compared to arthrodesis [11,12]. In addition, an improved mobility of the ankle joint is intended to reduce the risk of subsequent OA in adjacent joints [11][12][13][14][15][16]. Due to its inferior survival rates compared to hip and knee replacement, TAA was mainly recommended for older and less active patients in the past [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

High Reoperation Rate in Mobile-Bearing Total Ankle Arthroplasty in Young Patients

et al. 2022

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Background and Objectives: Due to inferior survival rates compared to hip and knee arthroplasty, total ankle arthroplasty (TAA) was previously mainly recommended for older and less active patients. However, given the encouraging survival rates and clinical outcomes of modern generations of TAA, some authors have also advocated TAA in young patients. Thus, the aim of this study was to evaluate age related reoperation, revision and survival rates of third-generation mobile-bearing TAAs. Materials and Methods: In this retrospective study, 224 consecutive TAA patients with a minimum follow up (FU) of 2 years were analyzed. Patients were retrospectively assigned to two study groups (Group A: age < 50 years; Group B: age ≥ 50 years). Revision was defined as secondary surgery with prothesis component removal, while reoperation was defined as a non-revisional secondary surgery involving the ankle. Results: After a mean FU of 7.1 ± 3.2 years, the reoperation rate (Group A: 22.2%; Group B: 5.3%; p = 0.003) and revision rate (Group A: 36.1%; Group B: 13.8%; p = 0.003) were higher within Group A. An age of under 50 years at time of surgery was associated with higher reoperation (odds ratio (OR): 6.54 (95% CI: 1.96–21.8); p = 0.002) and revision rates (OR: 3.13 (95% CI: 1.22–8.04); p = 0.018). Overall, lower patient age was associated with higher reoperation (p = 0.009) and revision rates (p = 0.001). Conclusions: The ideal indication for TAA remains controversial, especially regarding patient age. The findings of this study show high reoperation and revision rates in patients aged under 50 years at time of surgery. Therefore, the outcomes of this study suggest that the indication for TAA in young patients should be considered very carefully and that the association between low patient age and high reoperation rate should be disclosed to all eligible patients.

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Complications Following Total Ankle Arthroplasty Versus Ankle Arthrodesis for Primary Ankle Osteoarthritis

Cited by 14 publications

References 35 publications

Total Ankle Replacement Provides Symmetrical Postoperative Kinematics: A Biplane Fluoroscopy Imaging Study

Total Ankle Replacement Provides Symmetrical Postoperative Kinematics: A Biplane Fluoroscopy Imaging Study

Two-Year Revision Rates in Total Ankle Replacement Versus Ankle Arthrodesis

High Reoperation Rate in Mobile-Bearing Total Ankle Arthroplasty in Young Patients

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