Patient-Reported Outcomes of Primary Total Ankle Arthroplasty in Patients Aged <50 Years

Abstract

Background: Compared to more prevalent arthritic conditions, ankle arthritis is complicated by an earlier age of onset. Recently published data demonstrates excellent survivorship and complication rates in short-/midterm follow-up of younger patients who received a primary total ankle arthroplasty (TAA). Additionally, older TAA patients display comparable reported outcomes relative to hip/knee arthroplasty. However, there remains a paucity of literature surrounding the reported outcomes of younger patients undergoing TAA. Thus, our aim was to assess the reported outcomes of individuals aged &lt;50 years receiving a primary TAA. Methods: A retrospective cohort analysis of adult patients &lt;50 years who received a primary total ankle replacement was conducted. Patient demographics, diagnosis, treatment, and outcome characteristics were recorded from a chart review of 41 patients with at least 1 year of postoperative clinical follow-up. Postoperative reported outcomes were obtained via telephone interviews. Primary outcomes that were measured included emotional and physical health, activity limitation, ambulation, and global health. Measures used included the 36-Item Short Form Health Survey (SF-36), Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health, and Sickness Impact Profile Ambulation. The functional outcomes in our study sample were compared with age- and gender-matched norms from a general US population, and 95% CIs were calculated for each functional outcome mean. Student t test was used for continuous variables, and χ2 analysis was used for categorical variables. Results: Thirty-one of 41 eligible patients were reached for interview. The average age at surgery was 39.7 years. Clinical and radiographic follow-up was a mean of 51.6 months and 31.2 months following TAA, respectively. General health as measured with the SF-36 was not significantly different from age-/gender-matched norms. Eighty-seven percent of patients would choose to have a TAA again. Although 58% reported being limited in vigorous activities, 61% were able to ambulate frequently for long periods of time. On average, the patients did not report ongoing pain, and only 16% reported fatigue that hindered activities. Eighty-one percent reported returning to full employment and performing their duties without difficulty, and 84% reported they resumed all normal social activities. Primary implant survivorship was 93%. Conclusion: Despite a younger age and potentially increased demands, patients aged &lt;50 years undergoing primary TAA are generally satisfied with their index procedure at a mean follow-up of nearly 5 years. Our findings of positive outcomes on their health and well-being may improve surgeon insight for TAA as an alternative treatment for younger individuals with end-stage ankle arthritis. Level of Evidence: Level IV, case series.

Outcomes After Total Ankle Arthroplasty in Patients Aged ≤50 Years at Midterm Follow-up

“…However, 58% of patients were limited in vigorous activity. 26 Our study shows a statistically significant improvement in functional outcomes at both the 1-year postoperative visit and at final follow-up ≥5 years postoperation. We did find a nonsignificant decrease in improvement from 1 year postoperation to the final follow-up.…”

“…Notably the minimum follow-up for their study was 1 year. 26 Umbel et al published favorable outcomes and complication rates in patients <55 years of age undergoing TAA. Similarly, however, their follow-up was relatively short with a mean follow-up time of 31.2 months.…”

“…Several studies have shown similar outcomes and survivorship among younger patients and elderly after TAA. 8,9,26,33 Despite this, many surgeons remain hesitant to perform TAA in younger patients because of the lack of long-term data on patient outcomes and survivorship, particularly in patients <50 years of age.…”

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

“…Previous studies indicate that improving outcomes following TAR are due to continually evolving surgical techniques, implants, and postoperative care and guidance. 25 , 36 Similarly, decreased use of TAR explant surgery is likely secondary to more advanced implants that are more amendable to revision surgery—primarily due to the use of more biocompatible materials, modular implants, and precision surgical techniques that minimize bone resection. 4 , 5 To our knowledge, this is the first study to report trends in the incidence of TAR revision and explant procedures in a national sample.…”

“… 12 , 35 Studies indicate that more than 5000 TARs are being performed globally each year with high levels of long-term postoperative satisfaction. 1 , 12 , 20 , 21 , 24 , 25 , 28 , 29 , 36 Notably, most of these studies have used either large billing-claims databases or been limited to small institutional studies. Importantly, the trends and predictors of revision surgery following TAR have not been well characterized.…”