Safety and efficacy of total ankle arthroplasty versus ankle arthrodesis for ankle osteoarthritis: A systematic review and meta-analysis

Almutairi, Tourki Abdulmhsen; Ragab, Khaled Mohamed; Elsayed, Sarah; Elsnhory, Ahmed Bostamy; Elhady, Mahmoud M.; Gamal, Mohamed; Fathallah, Ahmed Hashem

doi:10.1016/j.foot.2023.101980

Cited by 7 publications

(2 citation statements)

References 36 publications

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“…Despite the abundant literature showing several advantages of TAA compared to ankle arthrodesis, [1][2][3]28,30,31,34 ideal surgical options for younger age patients remains an important topic of debate when considering TAA. Several studies have shown similar outcomes and survivorship among younger patients and elderly after TAA.…”

Section: Introductionmentioning

confidence: 99%

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

Giambelluca,

Umbel,

Anastasio

et al. 2024

Foot Ankle Int.

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Background: Ankle arthritis differs from arthritis of the hip and knee in that 80% is posttraumatic and thus often occurs in a younger patient population. The literature supporting total ankle arthroplasty (TAA) in younger patients has increased over recent years and has bolstered the argument that in the short term, TAA in younger patients has successful outcomes that are comparable to older, lower-demand patients. The purpose of our study was to evaluate patient-reported outcomes (PROs) and implant survivorship at midterm after primary TAA in patients ≤ 50 years of age at the time of surgery. Methods: A retrospective chart review was conducted of patients ≤ 50 years of age who underwent primary TAA at a single institution from 2000 to 2017. Patient demographics, outcome measures, and complications were recorded. All patients had a minimum clinical follow-up of 5 years. PRO measures were evaluated at preoperative, 1-year postoperative, and final follow-up visits. Paired t tests were performed to compare individual patient changes in PROs from preoperative. Implant survivorship was evaluated based on need for revision of either the tibial or talar component. The need for additional surgery related to the TAA was also evaluated. Results A total of 58 patients were included. The average age at the time of the index surgery was 43.3 years (range 22-50 years). All patients had a minimum follow-up of 5 years with a mean follow-up of 8.8 years. A total of 11 patients required additional surgery related to their TAA. Six patients (10.3%) required bone grafting of peri-implant cysts, 3 patients (5.2 %) required gutter debridement, and 1 patient underwent complete revision of metal components. Mean visual analog scale, 36-item Short Form Health Survey, Short Musculoskeletal Function Assessment, and American Orthopaedic Foot & Ankle Society hindfoot scores significantly improved from preoperative to 1-year postoperative and final postoperative follow-up. Conclusion: The patients aged ≤50 years treated with a TAA whom we have been able to observe for a minimum of 5 years showed generally maintained improvement in functional scores and thus far have had a relatively low rate of secondary surgeries. Level of Evidence: Level III, retrospective cohort study.

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Section: Introductionmentioning

confidence: 99%

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

Giambelluca,

Umbel,

Anastasio

et al. 2024

Foot Ankle Int.

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“…3 Diabetes has been identified as a risk factor for various complications after lower extremity arthroplasty, such as surgical site infections, urinary tract infections, pneumonia, and stroke, among others. 1,2,4,7,10,11,13,17 In addition, the risk of infections in patients with insulin-dependent diabetes may differ from that in patients with non-insulin-dependent diabetes. Iorio et al and Meding et al reported higher infection rates after total joint arthroplasty in patients with insulin-dependent diabetes than those with non-insulin-dependent diabetes.…”

Section: Introductionmentioning

confidence: 99%

Do Patients With Insulin-Dependent and Non–Insulin-Dependent Diabetes Have Different Risks for Complications After Total Ankle Arthroplasty?

Qureshi,

Lin,

Anil

et al. 2024

Foot Ankle Int.

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Background: Patients with diabetes undergoing total ankle arthroplasty tend to be at greater risk for complications than those without diabetes. However, the effect of diabetes severity and how it impacts the risk for perioperative complications is less clear. The purpose of this study was to compare (1) complications, (2) length of hospital stay, and (3) readmissions within 30 days for total ankle arthroplasty (TAA) patients without diabetes, patients with non–insulin-dependent diabetes, and patients with insulin-dependent diabetes. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, a total of 1803 patients undergoing TAA between 2007 and 2019 were collected. The relationship between diabetes status (no diabetes [n = 1,589], insulin-dependent [n = 169], and non–insulin-dependent [n = 45]) and outcomes were compared. Multivariate linear regression models were used to adjust for confounding variables such as age, sex, race, body mass index, smoking, steroid use, hypertension, chronic obstructive pulmonary disease, anesthesia type, dyspnea, and outpatient status. Statistical significance was set at P <.05. Results: Insulin-dependent diabetes was an independent risk factor for increased odds of infection within 30 days (odds ratio 6.47, 95% CI 0.79-33.66; P = .043). Hospital length of stay was also increased in patients with non–insulin-dependent diabetes (β = 0.21, 95% CI 0.02-0.40; P = .031) and insulin-dependent diabetes (β = 0.40, 95% CI 0.04-0.76; P = .028). However, neither diabetic state demonstrated a statistically significant increase in readmissions or wound complications within 30 days. Conclusion: Patients with insulin-dependent diabetes included in this cohort were at increased risk of having an infection within 30 days after TAA. Additionally, patients with diabetes status had an increased hospital length of stay. These results can inform patients on their potential outcomes after total ankle arthroplasty based on their diabetes status. Level of Evidence: Level III, retrospective comparative study.

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Accuracy of patient‐specific instrumentation for implant positioning in custom‐made total ankle arthroplasty

Mazzotti,

Zielli,

Arceri

et al. 2024

J. exp. orthop.

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PurposeThis retrospective radiological analysis aimed to assess the accuracy of implant positioning in patients with ankle arthritis undergoing custom‐made total ankle arthroplasty (TAA) with patient‐specific instrumentation (PSI) compared with preoperative planning.MethodsPatients who underwent custom‐made TAA with PSI from January 2018 to March 2023 were retrospectively evaluated, focusing on the tibial anterior surface (TAS) angle, tibial lateral surface (TLS) angle and tibiotalar ratio (TTR). Additionally, data regarding the time from the preoperative computed tomography (CT) scan to surgery, associated procedures and complications were recorded.ResultsNo associated procedures were performed, and only one intraoperative complication, an iatrogenic lateral malleolar fracture, was recorded. In the coronal plane, custom‐made TAA with PSI consistently achieved precise positioning of prosthetic components, even in cases with significant preoperative deformities or bone deficits. However, a statistically significant deviation from the planned values was observed in the sagittal plane (p = 0.007). A notable correlation was identified between the time elapsed from the preoperative CT scan to surgery and the deviation from the planned to the actual postoperative TAS angle (p < 0.001).ConclusionThis study underscores the efficacy of PSI systems in achieving precise positioning in the coronal plane, in accordance with preoperative planning. In contrast, sagittal plane positioning did not demonstrate the same level of accuracy, as evidenced by a statistically significant difference between the planned and postoperative TLS values. Nevertheless, all measurements remained within the recommended range according to the existing literature.Level of EvidenceLevel IV.

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Safety and efficacy of total ankle arthroplasty versus ankle arthrodesis for ankle osteoarthritis: A systematic review and meta-analysis

Cited by 7 publications

References 36 publications

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

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

Do Patients With Insulin-Dependent and Non–Insulin-Dependent Diabetes Have Different Risks for Complications After Total Ankle Arthroplasty?

Accuracy of patient‐specific instrumentation for implant positioning in custom‐made total ankle arthroplasty

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