Risk factors for total ankle arthroplasty failure: A Dutch Arthroplasty Register study

Background Studies have shown conflicting results regarding associations of preoperative comorbidities with outcomes after total ankle arthroplasty (TAA). Our aim was to analyze preoperative risk factors for complications, longer hospital stay, and readmission within 30 days after TAA. Methods We conducted a retrospective study using the American College of Surgeons National Surgical Quality Improvement Program database. We included 294 patients who underwent TAA from 2009 through 2012. We used multivariate logistic regression to identify risk factors for complications, longer hospital stay, and hospital readmission. Results Surgical site infection was the most common complication. Diabetes was associated with greater odds of complications as was current smoker status. Notably, obesity was not associated with greater odds of complications. Age, chronic obstructive pulmonary disease, and diabetes mellitus were associated with longer hospital stays. Surgical site infection was the most common reason for hospital readmission. Conclusions TAA has a low complication rate, with surgical site infection being the most common complication and the most common reason for hospital readmission. Patients with diabetes have greater odds of poor outcomes and prolonged hospital stays after TAA than patients without diabetes. Obesity was not associated with poor outcomes after TAA. Levels of Evidence: Level III

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Time trends and risk factors for perioperative complications in total ankle arthroplasty: retrospective analysis using a national database in Japan

BMC Musculoskeletal Disorders ◽

10.1186/s12891-016-1299-x ◽

2016 ◽

Vol 17 (1) ◽

Cited By ~ 8

Author(s):

Takumi Matsumoto ◽

Hideo Yasunaga ◽

Hiroki Matsui ◽

Kiyohide Fushimi ◽

Naohiro Izawa ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Analysis ◽

Time Trends ◽

Perioperative Complications ◽

Total Ankle Arthroplasty ◽

National Database ◽

Ankle Arthroplasty

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Patients at Risk for Exceeding CJR Cost Targets After Total Ankle Arthroplasty

Foot & Ankle International ◽

10.1177/1071100719853494 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1025-1031 ◽

Cited By ~ 1

Author(s):

Daniel E. Goltz ◽

Sean P. Ryan ◽

Claire B. Howell ◽

Michael P. Bolognesi ◽

Thorsten M. Seyler ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Average Cost ◽

Query Language ◽

Cost Of Care ◽

Total Ankle Arthroplasty ◽

Index Number ◽

Level Of Evidence ◽

Ankle Arthroplasty ◽

Target Cost

Background: The Comprehensive Care for Joint Replacement (CJR) model includes total ankle arthroplasty (TAA), under which a target reimbursement is established. Whether this reimbursement is sufficient to cover average cost remains unknown. We hypothesized that a substantial number of TAAs still exceed cost targets, and that risk factors associated with exceeding the target cost could be identified preoperatively. Methods: Two hundred two primary TAAs performed at a single tertiary referral center under the CJR model from June 2013 to May 2017 were retrospectively reviewed. Patient demographics, comorbidities, outcomes, and costs were extracted from the electronic medical record using a validated structured query language (SQL) algorithm. A comparison cohort of 2084 CJR total hip arthroplasty (THA) and total knee arthroplasty (TKA) cases performed during the same period was also reviewed. Results: Twenty TAAs (10%) exceeded the target cost of care, significantly fewer than CJR THAs/TKAs (29%) performed during the same period ( P < .0001). These patients did not differ significantly in age, sex, body mass index, number of Elixhauser comorbidities, or the American Society of Anesthesiologists score. The average cost for these patients was $17 338 higher than those who did not exceed the target cost, and they were less likely to be married or have a partner (45% vs 79%, P = .001). Non-Caucasian status also reached significance ( P < .0001). Those exceeding the target cost had a significantly longer length of stay (2.6 vs 1.5 days, P < .0001) and were more likely to be discharged to either skilled nursing or a rehabilitation facility (60% vs 1%, P < .0001). Conclusion: Even high-volume TAA centers still exceed target costs in up to 10% of cases, with length of stay, discharge location, and readmissions driving many of these events. Potential risk factors for excess cost include marital/partner status and non-Caucasian ethnicity, but further work is needed to clarify their effects and whether other risk factors exist. Level of Evidence: Level III, comparative study.

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Total Ankle Arthroplasty Survival and Risk Factors for Failure

Foot & Ankle International ◽

10.1177/1071100719849084 ◽

2019 ◽

Vol 40 (9) ◽

pp. 997-1006 ◽

Cited By ~ 5

Author(s):

Mario I. Escudero ◽

Vu Le ◽

Maximiliano Barahona ◽

Michael Symes ◽

Kevin Wing ◽

...

Keyword(s):

Risk Factors ◽

Predictive Model ◽

Patient Characteristics ◽

Total Ankle Arthroplasty ◽

Ankle Arthritis ◽

Level Of Evidence ◽

Ankle Arthroplasty ◽

Radiographic Parameters ◽

Patient Reported ◽

Component Revision

Background: Total ankle arthroplasty (TAA) is an increasingly selected treatment for end-stage ankle arthritis; however, failure and revision of the tibial and talar components remains an issue. Although multiple risk factors have been shown to contribute to early component revision, no study has looked at combining such risk factors into a predictive model that could potentially decrease revision rates and improve implant survival. This study aimed to develop a predictive model for TAA failure based on patient characteristics, patient-reported outcomes (PROs), and immediate postoperative radiographs. Methods: A retrospective review of a single-site ankle arthritis database was conducted. All patients with current-generation ankle replacements including the Hintegra and Infinity prostheses implanted between 2004 and 2015 and with complete postoperative radiographs taken between 6 and 12 weeks postoperatively were included. Eight coronal and sagittal radiographic parameters were assessed and performed twice by 2 independent orthopedic surgeons on included TAAs. These radiographic parameters were then analyzed in association with patient demographics and PRO. Advanced statistical methods including survival analysis were used to construct a predictive model for TAA survival. A total of 107 patients were included and analyzed with a median clinical follow-up of 49 months (minimum 24 months). Results: A predictive model was created, with 4 parameters identified as being statistically associated with TAA metal-component revision: diabetes mellitus, poor baseline Ankle Osteoarthritis Scale (AOS) score, excessively dorsiflexed talar component, and an anteriorly/posteriorly translated talus relative to the tibial axis. The presence of 3 parameters predicted TAA survival of 0.60 whereas presence of all 4 parameters predicted survival of only 0.13 in the period studied. Conclusion: Our predictive model is based on a combination of patient factors, PROs, and radiographic TAA alignment. We believe it can be used by surgeons to predict failure in their TAA patients, thereby optimizing postoperative outcomes by improving patient selection and modifiable outcome-specific parameters. Level of Evidence: Level III, retrospective cohort study using prospectively collected data.

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Risk Factors for Early Failure of 4th Generation Total Ankle Arthroplasty Prostheses

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00420 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0042

Author(s):

Calvin J. Rushing ◽

Christopher F. Hyer ◽

Gregory C. Berlet

Keyword(s):

Risk Factors ◽

Revision Surgery ◽

Distal Tibia ◽

Total Ankle Arthroplasty ◽

Early Failure ◽

Ankle Arthroplasty ◽

Patient Demographics ◽

Independent Risk Factors ◽

Hindfoot Fusion

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: A number of two-component, 4th generation total ankle arthroplasty (TAA) prostheses have been introduced to the market in the past few years, as the popularity and indications for TAA have continued to expand. The purpose of the present study was to identify independent risk factors for the early failure of 4th generation TAA prostheses. Methods: A total of 97 ankles underwent TAA with a 4th generation prostheses (INFINITY, CADENCE) between August 2015 and June 2018 at a single institution and were at least 6 months postoperative (mean 18.3 months, range 6-43). The primary outcome assessed was the need for revision surgery, defined as removal of 1 or both metal components for any reason, excluding infection. Baseline patient demographics, characteristics, radiographic alignment parameters, and distal tibia cortical bone thickness (CBT) were assessed. Revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al. and Glazebrook et el., respectively. Univariate and multivariate analyses were performed. Results: Three ankles (3.1%) underwent revision surgery for aseptic loosening at a mean of 24.3 (range, 16-31) months; all had a CBT <4mm. Independent predictors for reoperation were a CBT < 4mm, the presence of diabetes, and ipsilateral hindfoot fusion (p=0.04). No associations were identified for purported risk factors (age, BMI, and coronal deformity). Conclusion: The present study is the first to suggest a potential relationship between CBT of the distal tibia and TAA failure. Additional studies are warranted to better understand the role of bone density in TAA survivorship.

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Risk Factors for Failure of Total Ankle Arthroplasty With a Minimum Five Years of Follow-up

Fuß & Sprunggelenk ◽

10.1016/j.fuspru.2019.06.007 ◽

2019 ◽

Vol 17 (3) ◽

pp. 179

Keyword(s):

Risk Factors ◽

Total Ankle Arthroplasty ◽

Ankle Arthroplasty

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Short-Term Outcomes of Primary Total Ankle Arthroplasty in Octogenarians: A National Database Analysis

Foot & Ankle Specialist ◽

10.1177/1938640020960546 ◽

2020 ◽

pp. 193864002096054

Author(s):

Matthew Partan ◽

Nicholas Frane ◽

Cesar Iturriaga ◽

Prashant Matai ◽

Adam Bitterman

Keyword(s):

Risk Factors ◽

The Elderly ◽

Adverse Outcomes ◽

Total Ankle Arthroplasty ◽

Hospital Length Of Stay ◽

National Database ◽

Short Term ◽

Ankle Arthroplasty ◽

Increased Risk ◽

Independent Risk Factors

Background Total ankle arthroplasty (TAA) is an increasingly popular option for end-stage ankle arthritis. Americans over the age of 80 years grew to 16.7 million in 2010, but there are scarce data assessing the outcomes of octogenarians undergoing TAA. This study evaluated (1) perioperative factors, (2) 30-day postoperative complications compared to a nonoctogenarian cohort, and (3) independent risk factors for adverse outcomes. Methods A national database registry was queried for patients who had undergone primary TAA. This yielded 1113 patients, under (n = 1059) and over (n = 54) age 80 years. Demographics and perioperative data were compared using Fisher’s exact, χ2, and independent-samples t tests. Logistic and Poisson regressions were used to calculate odds ratio (OR) of complications and independent risk factors. Results The octogenarian cohort had longer in-hospital length of stay (1.9 vs 2.5 days, P < .0001). Octogenarians were not significantly more likely to develop any complication (OR = 1.32; 95% confidence interval = 0.29-6.04; P = .722), or increased number of complications (OR = 1.18; 95% CI = 0.27-5.18; P = .820). Octogenarians had significantly increased risk of being discharged to rehab/skilled nursing (OR = 6.60; 95% CI = 2.16-20.15; P < .001) instead of home. Conclusion Although the elderly population may carry inherent risk factors, octogenarians do not present an increased risk of short-term complications following TAA. Levels of Evidence Therapeutic, Level III: Retrospective cohort study.

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Risk factors associated with failure of total ankle arthroplasty: a nationwide cohort study

Scientific Reports ◽

10.1038/s41598-021-82674-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Dong Hun Suh ◽

Kyungdo Han ◽

Jin Woo Lee ◽

Hak Jun Kim ◽

Bongsung Kim ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Service Failure ◽

Group Versus ◽

Population Based ◽

Total Ankle Arthroplasty ◽

Age Group ◽

Ankle Arthroplasty ◽

Factors Associated ◽

Increased Risk

AbstractWe conducted a nationwide population-based cohort study to identify the risk factors associated with failure of total ankle arthroplasty (TAA). We included 2,914 subjects who underwent primary TAA between January 1, 2010, and December 31, 2016, utilizing the database of the Korean National Health Insurance Service. Failure of TAA was defined as revision TAA or arthrodesis procedures. An increased risk of TAA failure was observed in the < 65 age group versus the ≥ 75 age group [adjusted hazard ratios (aHR) 2.273, 95% confidence interval (CI) 1.223–4.226 in the 60–64 age group; aHR 2.697, 95% CI 1.405–5.178 in the 55–59 age group; aHR 2.281, 95% CI 1.145–4.543 in the 50–54 age group; aHR 2.851, 95% CI 1.311–6.203 in the < 50 age group]. Conversely, the ≥ 65 age group displayed no increase in the risk of TAA failure. The risk of TAA failure was increased in the severely obese group with body mass index (BMI) of ≥ 30 kg/m2 versus the normal BMI group (aHR 1.632; 95% CI 1.036–2.570). This population-based longitudinal study demonstrated that age < 65 years and BMI of ≥ 30 kg/m2 were associated with increased risk of TAA failure.

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