Short-Term Perioperative Complications and Mortality After Total Ankle Arthroplasty in the United States

Heida, Kenneth A.; Waterman, Brian R.; Tatro, Eric; Bader, Julia; McCoy, Andrew C.; Rensing, Nicholas; Orr, Justin D.

doi:10.1177/1938640017709912

Cited by 24 publications

(13 citation statements)

References 29 publications

(32 reference statements)

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“…Previous literature described that with TAA, higher comorbidity was not associated with readmission 20 , failure 14 , or revision 21 . However, the adverse impact of comorbidities on TAA complication has been previously documented by several authors 22,23 . Previous studies measured comorbidity with Deyo-Charlson index, without www.nature.com/scientificreports/ differentiating each comorbidity 7,14,21 .…”

Section: Discussionmentioning

confidence: 94%

Analysis of early failure rate and its risk factor with 2157 total ankle replacements

Lee

Song

et al. 2021

Sci Rep

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The failure rate of TAA is still higher than that of other joint replacement procedures. This study aimed to calculate the early failure rate and identify associated patient factors. Data from the Korean Health Insurance Review and Assessment Service database from 2009 to 2017 were collected. We evaluated patients who had TAA as a primary surgical procedure. Early failure was defined as conversion to revision TAA or arthrodesis after primary TAA within five years. Patients with early failure after primary TAA were designated as the “Failure group”. Patients without early failure and who were followed up unremarkably for at least five years after primary TAA were designated as the “No failure group”. Overall, 2157 TAA participants were included. During the study period, 197 patients developed failure within five years postoperatively, for an overall failure rate of 9.1%. Significant risk factors for early failure were history of chronic pulmonary disease, diabetes, peripheral vascular disease, hyperlipidemia, dementia, and alcohol abuse. A significant increase of odds ratio was found in patients with a history of dementia, chronic pulmonary disease, and diabetes. Surgical indications and preoperative patient counseling should consider these factors.

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Section: Discussionmentioning

confidence: 94%

Analysis of early failure rate and its risk factor with 2157 total ankle replacements

Lee

Song

et al. 2021

Sci Rep

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“…Our cohort’s leading causes of death were cancer, pulmonary issues, and cardiac issues, consistent with those studies, but suicide was a leading cause of death in our cohort that was not identified in the THA and TKA studies. Beyond joint replacement orthopedic surgery, mortality after noncervical spine surgery has an estimated short-term mortality of 0.4% to 0.7%, and even total shoulder and total ankle arthroplasty have nonnegligible short-term mortality rates. These studies emphasize how and why understanding the rates and causes of mortality after surgery is important to properly counsel patients.…”

Section: Discussionmentioning

confidence: 99%

Association Between Osseointegration of Lower Extremity Amputation and Mortality Among Adults

et al. 2022

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ImportanceTranscutaneous osseointegration post amputation (TOPA) creates a direct linkage between residual bone and an external prosthetic limb, providing superior mobility and quality of life compared with a socket prosthesis. The causes and potential risks of mortality after TOPA have not been investigated.ObjectiveTo investigate the association between TOPA and mortality and assess the potential risk factors.Design, Setting, and ParticipantsThis observational cohort study included all patients with amputation of a lower extremity who underwent TOPA between November 1, 2010, and October 31, 2021, at a specialty orthopedic practice and tertiary referral hospital in a major urban center. Patients lived on several continents and were followed up as long as 10 years.ExposuresTranscutaneous osseointegration post amputation, consisting of a permanent intramedullary implant passed transcutaneously through a stoma and connected to an external prosthetic limb.Main Outcomes and MeasuresDeath due to any cause. The hypotheses tested—that patient variables (sex, age, level of amputation, postosseointegration infection, and amputation etiology) may be associated with subsequent mortality—were formulated after initial data collection identifying which patients had died.ResultsA total of 485 patients were included in the analysis (345 men [71.1%] and 140 women [28.9%]), with a mean (SD) age at osseointegration of 49.1 (14.6) years among living patients or 61.2 (12.4) years among patients who had died. Nineteen patients (3.9%) died a mean (SD) of 2.2 (1.7) years (range, 58 days to 5 years) after osseointegration, including 17 (3.5%) who died of causes unrelated to osseointegration (most commonly cardiac issues) and 2 (0.4%) who died of direct osseointegration-related complications (infectious complications), of which 1 (0.2%) was coclassified as a preexisting health problem exacerbated by osseointegration (myocardial infarction after subsequent surgery to manage infection). No deaths occurred intraoperatively or during inpatient recuperation or acute recovery after index osseointegration (eg, cardiopulmonary events). Kaplan-Meier survival analysis with log-rank comparison and Cox proportional hazards regression modeling identified increased age (hazard ratio, 1.06 [95% CI, 1.02-1.09]) and vascular (odds ratio [OR], 4.73 [95% CI, 1.35-16.56]) or infectious (OR, 3.87 [95% CI, 1.31-11.40]) amputation etiology as risk factors. Notable factors not associated with mortality risk included postosseointegration infection and male sex.Conclusions and RelevanceThese findings suggest that patients who have undergone TOPA rarely die of problems associated with the procedure but instead usually die of unrelated causes.

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“…Comparable studies rely on large databases and likely underestimate complication rates. 1,4,8 This study based complications on chart review and likely overestimated the percentage of wound complications. Inclusion of some of these normal healing descriptors may have included more than what other studies would consider "minor wound complications."…”

Section: Declaration Of Conflicting Interestsmentioning

confidence: 99%

Comparison Between Closed Suction Drainage and No Drainage Following Total Ankle Arthroplasty

et al. 2022

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Background: The purpose of this study is to determine whether the use of closed suction drains after total ankle arthroplasty (TAA) is associated with lower wound complications in the first postoperative year as compared to no drain usage. Methods: A total of 324 TAA were reviewed and included for analysis. One hundred forty-four did not have a postoperative drain placed, whereas 180 did have a postoperative drain. Demographic data, including age, sex, tobacco or alcohol use, and various medical comorbidities, were obtained. Follow-up data were collected and reviewed at 2, 6, and 12 weeks; 6 months; and 1 year postoperatively for minor and major wound complications, as well as wound-related reoperations. Results: At the 2-week mark, the use of a drain demonstrated a significant increase in wound complications. No significant difference in wound complications was found at each subsequent follow-up visit. Within the first postoperative year, a total of 46 patients (31.9%) without drains and 69 patients (38.3%) with drains had a wound complication. This was not statistically significant. Most wound complications were minor, and no significant difference in reoperation rates occurred between the 2 groups. Conclusion: A postoperative closed suction drain may increase wound complications in the first 2 weeks after TAA and should therefore be used with caution. Level of Evidence: Level III, retrospective comparative study.

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Short-Term Perioperative Complications and Mortality After Total Ankle Arthroplasty in the United States

Abstract: Level III: Database case control study.

Cited by 24 publications

References 29 publications

Analysis of early failure rate and its risk factor with 2157 total ankle replacements

Analysis of early failure rate and its risk factor with 2157 total ankle replacements

Association Between Osseointegration of Lower Extremity Amputation and Mortality Among Adults

Comparison Between Closed Suction Drainage and No Drainage Following Total Ankle Arthroplasty

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