Effect of age on outcome and revision in total ankle arthroplasty

Abstract

Aims To assess the effect of age on clinical outcome and revision rates in patients who underwent total ankle arthroplasty (TAA) for end-stage ankle osteoarthritis (OA). Methods A consecutive series of 811 ankles (789 patients) that underwent TAA between May 2003 and December 2013 were enrolled. The influence of age on clinical outcome, including the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and pain according to the visual analogue scale (VAS) was assessed. In addition, the risk for revision surgery that includes soft tissue procedures, periarticular arthrodeses/osteotomies, ankle joint debridement, and/or inlay exchange (defined as minor revision), as well as the risk for revision surgery necessitating the exchange of any of the metallic components or removal of implant followed by ankle/hindfoot fusion (defined as major revision) was calculated. Results A significant improvement in the AOFAS hindfoot score and pain relief between the preoperative assessment and the last follow-up was evident. Age had a positive effect on pain relief. The risk for a minor or major revision was 28.7 % at the mean follow-up of 5.4 years and 11.0 % at a mean follow-up of 6.9 years respectively. The hazard of revision was not affected by age. Conclusion The clinical outcome, as well as the probability for revision surgery following TAA, is comparable between younger and older patients. The overall revision rate of the Hintegra total ankle is comparable with other three component designs. TAA should no longer be reserved for low demand elderly patients, but should also be recognized as a viable option for active patients of younger age. Cite this article: Bone Joint J 2020;102-B(7):925–932.

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

“…Nevertheless, some recent studies regarding modern TAA have questioned the indication of TAA in young patients. Satisfying outcomes including implant survival and reoperation rates with no significant difference to older patients have been more often reported recently [17][18][19][20]22,23], which is clearly in contrast to the findings of this study. For example, a retrospective cohort study conducted by Gaugler et al using the Hintegra implant in a cohort of 811 patients revealed no significant effect of age on the rates for minor or major revisions, while the clinical outcomes of younger and older patients were comparable with slightly better pain relief in older patients [20].…”

“…Satisfying outcomes including implant survival and reoperation rates with no significant difference to older patients have been more often reported recently [17][18][19][20]22,23], which is clearly in contrast to the findings of this study. For example, a retrospective cohort study conducted by Gaugler et al using the Hintegra implant in a cohort of 811 patients revealed no significant effect of age on the rates for minor or major revisions, while the clinical outcomes of younger and older patients were comparable with slightly better pain relief in older patients [20]. Similarly, Lee et al reported no significant difference in revisions rates and clinical outcomes related to age at time of surgery when using the Hintegra implant in a cohort of 117 patients [17].…”

“…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]. However, some recent publications have advocated for various TAA implants in young patients [17][18][19][20][21][22][23]. Gaugler et al and Lee et al reported no significant impact of age at time of surgery on the prothesis survival or reoperation rates for Hintegra TAA (Allegra Orthopaedics, Sydney, NSW, Australia) [17,20].…”

“…However, some recent publications have advocated for various TAA implants in young patients [17][18][19][20][21][22][23]. Gaugler et al and Lee et al reported no significant impact of age at time of surgery on the prothesis survival or reoperation rates for Hintegra TAA (Allegra Orthopaedics, Sydney, NSW, Australia) [17,20]. Rodrigues-Pinto et al analyzed the agerelated outcomes of the Salto mobile-bearing TAA (Tornier SA, Saint Ismier, France) within a mean follow up (FU) of 3.4 years and found no significant age-related differences in complication and prothesis survival rates [18].…”

Risk factors associated with failure of total ankle arthroplasty: a nationwide cohort study

“…Conversely, in a prospective study with a database of 538 ankle replacements, four implants (INBONE I, INBONE II, STAR, and Salto-Talaris) were used and age was not associated with higher failure rates in a multivariable logistic regression analysis 30 . A retrospective study 32 of 811 HINTEGRA total ankles reported that clinical outcomes and the probability of revision surgery after TAA were comparable between young and old patients; the risk of revision surgery is not affected by age.…”