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

Abstract

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.

Tibial Stem Extension versus Standard Configuration in Total Knee Arthroplasty: A Biomechanical Assessment According to Bone Properties

“…Medical practice reveals the following situations of a complicated primary TKA where a stem can be effective: when the bones have altered physical properties created by various diseases (osteoporosis, osteoarthritis, and rheumatoid arthritis), when the patients have extreme varus–valgus deformities [ 10 , 11 , 12 , 13 ], when there is a pre-existing proximal tibial defect, when there is a previously performed corrective osteotomy, when there is a large proximal tibial defect or necrosis, when the bones have malunited fractures, and in the situation when the patients’ particularities such as age or lifestyle overexert the implant [ 14 , 15 ]. Moreover, there is the case of some unexpected intraoperative events that may require additional implant fixation [ 16 , 17 , 18 ].…”