Systemic medical complications following total ankle arthroplasty: A review of the evidence

Curlewis, Keegan; Leung, Brook; Sinclair, L; Chan, Gareth; Bendall, Stephen; Ricketts, David

doi:10.1016/j.fas.2021.10.012

Cited by 6 publications

(5 citation statements)

References 34 publications

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“… 1 , 3 , 16 , 18 , 21 , 25 , 46 Overall, TAR has been shown to be a safe procedure, with good long-term outcomes. 5 However, the current study demonstrates that 8.4% of a large cohort of patients undergoing TAR visited the ED at least once during the 90-day postoperative period, with almost a quarter of those visiting the ED more than once. Rates of 90-day postoperative ED utilization are similar in other orthopaedic procedures, including 11.8% following total hip and knee arthroplasty, 30 8.3% following anterior cruciate ligament reconstruction, 13 and 11.9% following single-level anterior cervical discectomy and fusion.…”

Section: Discussionmentioning

confidence: 57%

Emergency Department Visits Within 90 Days of Total Ankle Replacement

Ratnasamy

Kammien

Gouzoulis

et al. 2022

Foot & Ankle Orthopaedics

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Background: Total ankle replacement (TAR) utilization in the United States has steeply increased in recent decades. Emergency department (ED) visits following TAR impacts patient satisfaction and health care costs and warrant exploration. Methods: This retrospective cohort study utilized the 2010 to 2019 M91Ortho PearlDiver data set to identify TAR patients with at least 90 days of follow-up. PearlDiver contains billing claims data across all sites of care throughout the United States for all indications for care. Patient factors extracted included age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which surgery was performed, insurance plan, and postoperative hospital length of stay. Ninety-day postoperative ED visit incidence, timing, frequency, and primary diagnoses were identified and compared to 1-year postoperative ED visit baseline data. Univariate and multivariate logistic regression analyses were used to determine risk factors for ED visits. Results: Of 5930 TAR patients identified, ED visits within 90 days were noted for 497 (8.4%) patients. Of all ED visits, 32.0% occurred within 2 weeks following surgery. Multivariate analysis revealed several predictors of ED utilization: younger age (odds ratio [OR] 1.35 per decade decrease), female sex (OR 1.20), higher ECI (OR 1.32 per 2-point increase), TAR performed in the western US (OR 1.34), and Medicaid coverage (OR 2.70; 1.71-4.22 relative to Medicare) ( P < .05 each). Surgical site issues comprised 78.0% of ED visits, with surgical site pain (57.0%) as the most common problem. Conclusion: Of 5930 TAR patients, 8.4% returned to the ED within 90 days of surgery, with predisposing demographic factors identified. The highest incidence of ED visits was in the first 2 postoperative weeks, and surgical site pain was the most common reason. Pain management pathways following TAR should be able to be adjusted to minimize the occurrence of postoperative ED visits, thereby improving patient experiences and decreasing health care utilization/costs. Level of Evidence: Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 57%

Emergency Department Visits Within 90 Days of Total Ankle Replacement

Ratnasamy

Kammien

Gouzoulis

et al. 2022

Foot & Ankle Orthopaedics

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“…Most prior studies have demonstrated a higher risk of postoperative complications including increased risk of PJI within 6 months of TAA, 2 greater minor wound complications, 14 and longer hospital stays in patients with diabetes following TAA. 4,16 Diabetes has also been associated with medical complications following TAA, including increased risk of blood transfusion, 16 pulmonary embolism, 6 cerebrovascular accident, 6 and urinary tract infection. 6 Yet, not all studies support the increased risk of adverse outcomes in patients with diabetes undergoing TAA.…”

Section: Discussionmentioning

confidence: 99%

“…4,16 Diabetes has also been associated with medical complications following TAA, including increased risk of blood transfusion, 16 pulmonary embolism, 6 cerebrovascular accident, 6 and urinary tract infection. 6 Yet, not all studies support the increased risk of adverse outcomes in patients with diabetes undergoing TAA. Gross et al 7 demonstrated similar functional outcome scores, complication rates, and failure rates between patients with diabetes and control patients.…”

Section: Discussionmentioning

confidence: 99%

Diabetes Mellitus and Total Ankle Arthroplasty Complications

Helbing,

Farley,

et al. 2024

Foot Ankle Int.

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Background: Postoperative infection, aseptic loosening, and perioperative medical complications after total ankle arthroplasty (TAA) are all devastating problems. While previous studies have shown diabetes as a risk factor predisposing patients to postoperative complications, not all literature supports this association following TAA. The goal of this study is to determine if diabetes influences midterm outcomes following TAA. Methods: An insurance database was utilized to identify patients undergoing TAA for ankle arthritis with a concurrent diagnosis of diabetes based on Current Procedural Terminology ( CPT) and International Classification of Diseases, Ninth Revision ( ICD-9) and Tenth Revision ( ICD-10), diagnosis and procedure codes from 2010 to 2021. The postoperative outcomes of all-cause revision, periprosthetic joint infection (PJI), septic revision, and aseptic revision were compared between patients with and without diabetes with a minimum 2-year follow-up using Kaplan-Meier and multivariate Cox proportional hazards analyses. Patient demographics, comorbidities, and Charlson Comorbidity Index were analyzed via univariate and multivariate analysis. Results: The study population included 8317 patients, 345 (4.1%) of whom had a concurrent diabetes diagnosis, who underwent TAA. After multivariate Cox proportional hazards analysis, the 5-year cumulative incidence of being coded as having PJI was 7.3% in patients with known diabetes compared to 3.9% in patients without known diabetes, with a 95% increased risk (hazard ratio [HR] 1.95, 95% CI 1.15-3.30, P = .01). Patients with diabetes also demonstrated a 5-year cumulative incidence of septic revision of 1.4% compared to 0.4% in those without, with a 363% increased risk (HR 4.63, 95% CI 1.22-17.52, P = .02). However, there was no difference in the 5-year cumulative incidence of all-cause revision TAA with 4.6% in patients with diabetes and 4.3% in those without (HR 1.29, 95% CI 0.69-2.44, P = .42) Conclusion: In this database, the 5-year risk of PJI and septic revision was higher among patients with diabetes compared to those without, but cumulative incidence of all-cause revision TAA was not different between groups. Level of Evidence: Level III, retrospective cohort database study.

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“…No symptomatic deep venous thrombosis was found during follow‐up. Although thromboembolism is not recorded as a common complication following TAR, 19 previous studies have included some form of prophylactic regime. Routine deep vein thrombosis prophylaxis is recommended for any lower limb replacement procedure, especially in the context of prolonged operation time and the application of bilateral tourniquets.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Total Ankle Replacement and Contralateral Ankle Arthrodesis for Bilateral Ankle Osteoarthritis: A Retrospective Study Focused on Clinical Outcomes and Cost‐effectiveness

Chen

et al. 2022

Orthopaedic Surgery

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Objective Total ankle replacement (TAR) and ankle arthrodesis (AA) are two common surgical treatment options for end‐stage ankle osteoarthritis. However, few reports compare the outcomes of simultaneous TAR and contralateral AA for bilateral ankle osteoarthritis. The aim of this study was to assess changes in pain, joint range of movement (ROM), functional outcomes, patient satisfaction, and cost‐effectiveness following simultaneous TAR and contralateral AA. Methods A retrospective study was conducted on 12 patients with bilateral end‐stage ankle osteoarthritis who underwent simultaneous TAR and contralateral AA in our institution between May 2016 and August 2018, and who had a minimum of two‐year follow‐up data. Clinical and radiological follow‐up data for all patients were collected after 4 months, 1 year and 2 years. The results were assessed clinically on a visual analogue scale (VAS) and included ROM, American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot score, and satisfaction questionnaire. The total hospital costs of patients were also recorded. Independent sample t tests were conducted to compare continuous variables between groups. Paired sample t ‐tests were conducted to compare changes from the preoperative to postoperative evaluations within each group. Results Both surgical groups presented with pain reduction ( P < 0.001) at the one‐year postoperative session, which was generally consistent until the two‐year follow‐up. There was a significant increase ( P < 0.001) in the mean AOFAS score postoperatively in both ankles. The functional outcomes at the one‐ and two‐year follow‐up were significantly better in patients in the TAR group than in those in the AA group ( P < 0.001). Joint ROM differences were observed between the two groups after surgery (decreased ankle ROM in arthrodesis, P < 0.001; increased ankle ROM in arthroplasty, P < 0.001). The mean satisfaction score was 2 (range, 1–4) for the TAR group and 3 (range, 1–5) for the AA group. A significant difference in the satisfaction score was observed between the two groups ( P = 0.036). Simultaneous TAR and contralateral AA was 34.1% less expensive than simultaneous bilateral TAR. No intraoperative complications were noted in either group. Wound healing occurred without problems within 2 weeks after surgery. No symptomatic deep venous thrombosis was found during follow‐up. Conclusion TAR had better patient‐perceived post‐operative function and preserves more anatomic sagittal plane motion compared to ankles undergoing AA. In addition, simultaneous TAR and contralateral AA are more cost‐effective than simultaneous bilateral TAR, with lower costs for the average patient.

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Systemic medical complications following total ankle arthroplasty: A review of the evidence

Cited by 6 publications

References 34 publications

Emergency Department Visits Within 90 Days of Total Ankle Replacement

Emergency Department Visits Within 90 Days of Total Ankle Replacement

Diabetes Mellitus and Total Ankle Arthroplasty Complications

Simultaneous Total Ankle Replacement and Contralateral Ankle Arthrodesis for Bilateral Ankle Osteoarthritis: A Retrospective Study Focused on Clinical Outcomes and Cost‐effectiveness

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