Total Ankle Arthroplasty Survivorship, Complication, and Revision Rates in Patients Younger Than 55 Years

Consul, Devon; Chu, Anson K.; Langan, Travis M.; Hyer, Christopher F.; Berlet, Gregory C.

doi:10.1177/1938640020980925

Cited by 12 publications

(9 citation statements)

References 26 publications

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“…Nevertheless, some recent studies regarding modern TAA have questioned the indication of TAA in young patients. Satisfying outcomes including implant survival and reoperation rates with no significant difference to older patients have been more often reported recently [17][18][19][20]22,23], which is clearly in contrast to the findings of this study. For example, a retrospective cohort study conducted by Gaugler et al using the Hintegra implant in a cohort of 811 patients revealed no significant effect of age on the rates for minor or major revisions, while the clinical outcomes of younger and older patients were comparable with slightly better pain relief in older patients [20].…”

Section: Discussioncontrasting

confidence: 99%

“…Due to its inferior survival rates compared to hip and knee replacement, TAA was mainly recommended for older and less active patients in the past [17][18][19]. However, some recent publications have advocated for various TAA implants in young patients [17][18][19][20][21][22][23]. Gaugler et al and Lee et al reported no significant impact of age at time of surgery on the prothesis survival or reoperation rates for Hintegra TAA (Allegra Orthopaedics, Sydney, NSW, Australia) [17,20].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…This is a major finding in terms of patient selection, since most patients (68%) were 50 to 75 years of age in our cohort and in registry-based literature 13,14 . While recent meta-analyses 4,13,14,28 and other case series showed no influence of age on the revision rate, younger age is usually associated with higher functional status in terms of the ability to perform demanding activities as well as with a higher rate of posttraumatic arthritis as the reason for the TAR 29 , both of which are suspected as risk factors for implant failure. Additionally, cohorts including a substantial portion of patients younger than 50 years are rare and have limited follow-up and sample sizes 15,16 , in contrast with our unique data set including 677 patients below the age of 50 years.…”

Section: Discussionmentioning

confidence: 95%

Survivorship of 4,748 Contemporary Total Ankle Replacements from the French Discharge Records Database

Dagneaux

Nogue

Mathieu

et al. 2022

Journal of Bone and Joint Surgery

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Background: Studies of survivorship of primary total ankle replacements (TARs) beyond 5 years have shown varying results among early and modern designs. National cohorts give valuable insights about TAR outcomes, revision risk factors, and specific designs. The purpose of this study was to investigate implant survivorship and risk factors for revision of contemporary TARs using our national database.Methods: This observational study included patients identified in the national PMSI (Programme médicalisé des systèmes d'information) database as having undergone TAR from 2010 to 2019. Demographics, discharge data, concomitant procedures, and type of implant were extracted. Kaplan-Meier estimations were performed to determine time to revision using metal component revision for implant failure and revision for deep infection as end points. Weighted Cox models were used for risk factor analysis, including risks of early revision (within the first 2 years). The adjusted hazard ratios (HR ADJ ) were reported with 95% confidence intervals.Results: A cohort of 4,748 patients was extracted. The mean age at surgery was 63 years; 43% of the patients were female. The mean follow-up was 5 years (range, 1 to 10 years). Revisions were noted in 817 cases (17%), including 734 with metal component revision and 83 with revision due to deep infection. The 1-year, 2-year, 5-year, and 10-year survivorship free of metal component revision was 95%, 90%, 84%, and 78%, respectively. Younger age, implants derived from second-generation designs, and an institutional volume of £10 TARs per year were found to be independent predictors of revision for any cause. In addition to the above factors (except for implant generation), male sex and concomitant osteotomies and/or fusion were found to be significant predictors for any early revision. Conclusions:The 10-year survivorship free of metal component revision after TAR was 78%, which was consistent with other national registries. Revisions were associated with young age, associated arthritis or deformities requiring concomitant fusion or osteotomy, and implants derived from second-generation designs. Institutions where >10 procedures were performed per year were associated with better TAR survivorship.

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“…They found the <55-year age group displayed the greatest improvement in AOFAS and SF-36 scores without differences in wound complications, revisions, and need for reoperation between the groups. 10 Recently, Consul and colleagues 8 reported their outcomes on patients aged <55 years (51 patients) undergoing primary TAA with a mean follow-up of 31 months. Overall implant survivorship was 94%, with 7 patients needing a return trip to the operating room.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Consul et al 8 reported a cohort of patients aged <55 years who underwent TAA demonstrating a survivorship of 94% at short- to midterm follow-up. Additional studies have shown comparable complications, survivorship, gait, and clinical outcomes in patients around 50 years of age in comparison to more elderly populations.…”

Section: Introductionmentioning

confidence: 99%

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

Ebaugh

Alford

Kutzarov³

et al. 2022

Foot & Ankle Orthopaedics

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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 <50 years receiving a primary TAA. Methods: A retrospective cohort analysis of adult patients <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 <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.

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Total Ankle Arthroplasty Survivorship, Complication, and Revision Rates in Patients Younger Than 55 Years

Cited by 12 publications

References 26 publications

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

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

Survivorship of 4,748 Contemporary Total Ankle Replacements from the French Discharge Records Database

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

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