Total ankle arthroplasty: what are the risks?

2018 ◽  
Vol 100-B (10) ◽  
pp. 1352-1358 ◽  
Author(s):  
T. M. Clough ◽  
F. Alvi ◽  
H. Majeed
Keyword(s):  
Informed Consent ◽  
Literature Review ◽  
Deep Infection ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Superficial Infection ◽  
Ankle Arthroplasty ◽  
Wound Healing Problems ◽  
Initial Hospital ◽  
Ankle Function

Aims Total ankle arthroplasty (TAA) surgery is complex and attracts a wide variety of complications. The literature lacks consistency in reporting adverse events and complications. The aim of this article is to provide a comprehensive analysis of each of these complications from a literature review, and to compare them with rates from our Unit, to aid clinicians with the process of informed consent. Patients and Methods A total of 278 consecutive total ankle arthroplasties (251 patients), performed by four surgeons over a six-year period in Wrightington Hospital (Wigan, United Kingdom) were prospectively reviewed. There were 143 men and 108 women with a mean age of 64 years (41 to 86). The data were recorded on each follow-up visit. Any complications either during initial hospital stay or subsequently reported on follow-ups were recorded, investigated, monitored, and treated as warranted. Literature search included the studies reporting the outcomes and complications of TAA implants. Results There were wound-healing problems in nine ankles (3.2%), superficial infection in 20 ankles (7.2%), and deep infection in six ankles (2.2%). Intraoperative fractures occurred in medial malleoli in 27 ankles (9.7%) and in lateral malleoli in four ankles (1.4%). Aseptic loosening and osteolysis were seen 16 ankles (5.8%). Fracture of the polyethylene component occurred in one ankle (0.4%) and edge-loading in seven ankles (2.5%). We observed medial gutter pain in 31 ankles (11.1%). The incidence of thromboembolism occurred in two ankles (0.7%). The results were found to be comparable to the previously reported complications of total ankle arthroplasty in the literature. Conclusion Total ankle arthroplasty continues to evolve and improve the ankle function. Despite high overall complication rates with TAA surgery, most complications appear to be minor and do not affect final clinical outcome. Our results and literature review will help in the consent process and provide detailed complication rates for an informed consent. Cite this article: Bone Joint J 2018;100-B:1352–8.

scholarly journals Effect of Travel Time and Distance on Outcomes in Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0015
Author(s):  
Kristin C. Caolo ◽  
Scott J. Ellis ◽  
Jonathan T. Deland ◽  
Constantine A. Demetracopoulos
Keyword(s):  
Travel Time ◽  
Complication Rate ◽  
High Volume ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Linear Regression Models ◽  
Ankle Arthroplasty ◽  
Significant Difference ◽  
Drive Time

Category: Ankle; Ankle Arthritis Introduction/Purpose: Surgeons who perform a higher volume of total ankle arthroplasty (TAA) are known to have decreased complication rates; evidence shows that low volume centers performing TAA have decreased survivorship when compared with high volume centers. Understanding differences in outcomes for patients traveling different distances for their TAA is important for future patients deciding where to travel for their surgery. No study has previously examined differences in outcomes of patients traveling different distances to a high volume center for their TAA. This study compares preoperative and postoperative PROMIS scores for patients undergoing total ankle arthroplasty who traveled less than and more than 50 miles for their TAA. We hypothesized that there would be no difference in outcome scores based on distance traveled or estimated drive time. Methods: This study is a single center retrospective review of 162 patients undergoing primary total ankle arthroplasty between January 2016 and December 2018. We collected the primary address as listed in the patient’s medical record and used the directions feature on Google Maps to estimate driving mileage and estimated driving time from the patient’s address to the hospital. To analyze the distance patients traveled, patients were divided into two groups: <50 miles traveled (n=91) and >50 miles traveled (n=71). To analyze the estimated drive time, patients were divided into two groups: <90 minutes (n=77), >90 minutes (n=85). We collected preoperative and most recent postoperative PROMIS scores for all patients. Differences in most recent post-operative PROMIS scores between distance groups and travel time groups were assessed using multivariable linear regression models, adjusting for the pre-operative score and follow-up time. Results: We found no significant difference in post-operative PROMIS scores between the two groups when analyzed for distance traveled or for estimated travel time after adjustment for pre-operative PROMIS score and follow-up time (Table 1). The average follow-up for all 162 patients was 1.49 years. Power analysis showed that with a sample size of 110 (55 in each group), we had 81% power to detect an effect size of 4. Patients saw an increase in their Physical Function scores and a decrease in their Pain Interference and Pain Intensity scores with postoperative scores better than population means (Table 1). Overall complication rate for the <50 miles group was 17.6%, 7.7% required surgery. The >50 miles group had an overall complication rate of 24.0%, 9.9% required surgery. Conclusion: Patients traveling further distances to a high volume orthopedic specialty hospital for their total ankle arthroplasty do not have different clinical outcomes than patients traveling shorter distances. This is particularly important for patients deciding where to have their total ankle arthroplasty surgery. Patients who travel further have the opportunity to be treated at a local academic center; however our results show that outcomes do not change when traveling further for total ankle arthroplasty. [Table: see text]

scholarly journals A Comparative Analysis of Short Term Postoperative Complications in Outpatient vs. Inpatient Total Ankle Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0042 ◽  
Author(s):  
Ashish Shah ◽  
Henry DeBell ◽  
Chandler Tedder ◽  
Zachariah Pinter ◽  
Sameer Naranje ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Renal Failure ◽  
Hospital Stay ◽  
Operating Room ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Inpatient Setting ◽  
Complication Rates ◽  
Ankle Arthroplasty ◽  
Significant Difference

Category: Ankle Introduction/Purpose: Ankle arthritis is a potentially debilitating disease with approximately 50,000 cases diagnosed annually. Once conservative management fails, surgical options for these patients include total ankle arthroplasty (TAA) and ankle arthrodesis. Younger, more active patients may prefer TAA as it may allow better ankle mobility compared to ankle arthrodesis. TAA has historically been performed in the inpatient setting with a one- to two-night postoperative hospital stay. Outpatient surgeries are gaining popularity due to their cost effectiveness, decreased length of hospital stay, and convenience. Therefore, it is important to evaluate the safety of specific procedures in the outpatient setting compared to the inpatient setting. This study evaluates the complication rates in inpatient vs. outpatient TAA. Methods: Our team conducted a retrospective analysis of data from 591 patients receiving inpatient and outpatient TAA from the NSQIP database. This database contains de-identified patient data and allows retrospective analyses to be performed based on data they have extracted from over 400 hospitals. Demographic information was recorded including age, sex, weight, height, and race. Thirty-day postoperative complication rates were compared between 66 outpatients and 535 inpatients. Frequencies of the following complications were analyzed: wound complications, pneumonia, hematologic complications (pulmonary embolism and deep vein thrombosis), renal failure, stroke, and return to the operating room within 30 days. The inpatient and outpatient groups were compared using chi-squared tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. Results: 591 total patients were identified that underwent TAA. 66 patients (11.1%) were treated as outpatients and 525 (88.8%) as inpatients. Inpatient TAA had a significantly higher mean operation time (161 min vs 148 min) and a significant difference in length of total hospital stay (2.3 days vs 1.1 days). Inpatients had higher rates of superficial incisional surgical site infection (SSI) (0.57% vs 0%), deep SSI (0.19 % vs 0%), organ/space SSI (0.19% vs 0%), pneumonia (0.38% vs 0%), and return to the operating room (0.76% to 0%). However, no significant differences were found in complication rates between inpatient and outpatient groups. There were no occurrences of acute renal failure, wound disruption, pulmonary embolism, stroke, or DVT/thrombophlebitis for inpatients or outpatients. Conclusion: We found no significant difference between inpatient vs. outpatient TAA. Incidental differences we found were that inpatients were significantly more likely to be older in age, diagnosed with diabetes, and inpatients had longer operative times. Our results suggest that inpatients are more likely, but not significantly, to have a higher occurrence of complications and return to the OR. Therefore, this study suggests that outpatient TAA is safe and may be a superior option for the correct patient population. Further investigation is warranted to verify these conclusions.

A Review of Perioperative Complications of Outpatient Total Ankle Arthroplasty

2017 ◽  
Vol 39 (2) ◽  
pp. 143-148 ◽  
Author(s):  
Todd R. Borenstein ◽  
Kapil Anand ◽  
Quanlin Li ◽  
Timothy P. Charlton ◽  
David B. Thordarson
Keyword(s):  
Wound Infection ◽  
Pain Control ◽  
Perioperative Complications ◽  
Case Series ◽  
Arterial Occlusion ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Ankle Arthroplasty ◽  
Wound Breakdown

Background: Total ankle arthroplasty (TAA) is commonly pursued for patients with painful arthritis. Outpatient TAA are increasingly common and have been shown to decrease costs compared to inpatient surgery. However, there are very few studies examining the safety of outpatient TAA. In this study, we retrospectively reviewed 65 consecutive patients who received outpatient TAA to identify complication rates. Methods: The medical records of 65 consecutive outpatient TAA from October 2012 to May 2016 with a minimum 6-month follow-up were reviewed. All patients received popliteal and saphenous blocks prior to surgery and were managed with oral pain medication postoperatively. All received a STAR total ankle. Demographics, comorbidities, American Society of Anesthesiologists (ASA) class, and perioperative complications including wound breakdown, infection, revision, and nonrevision surgeries were observed. Mean follow-up was 16.6 ± 9.1 months (range, 6-42 months). Results: There were no readmissions for pain control and 1 patient had a wound infection. The overall complication rate was 15.4%. One ankle (1.5%) had a wound breakdown requiring debridement and flap coverage. This patient thrombosed a popliteal artery stent 1 month postop. The 1 ankle (1.5%) with a wound infection occurred in a patient with diabetes, obesity, hypertension, and rheumatoid arthritis. Conclusion: This study demonstrates the safety of outpatient TAA. The combination of regional anesthesia and oral narcotics provided a satisfactory experience with no readmissions for pain control and 1 wound infection. The 1 wound breakdown complication (1.5%) was attributed to arterial occlusion and not outpatient management. Level of Evidence: Level IV, retrospective case series.

scholarly journals Complication rates after total ankle arthroplasty in one hundred consecutive prostheses

2013 ◽  
Vol 37 (9) ◽  
pp. 1789-1794 ◽  
Author(s):  
Stephanie Noelle ◽  
Claus C. Egidy ◽  
Michael B. Cross ◽  
Matthias Gebauer ◽  
Wolfgang Klauser
Keyword(s):  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Ankle Arthroplasty

Association of Cigarette Use and Complication Rates and Outcomes Following Total Ankle Arthroplasty

2016 ◽  
Vol 37 (10) ◽  
pp. 1052-1059 ◽  
Author(s):  
Alexander Lampley ◽  
Christopher E. Gross ◽  
Cynthia L. Green ◽  
James K. DeOrio ◽  
Mark Easley ◽  
...  
Keyword(s):  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Cigarette Use ◽  
Ankle Arthroplasty

Economic Analysis and Patient Satisfaction Associated With Outpatient Total Ankle Arthroplasty

2017 ◽  
Vol 38 (5) ◽  
pp. 507-513 ◽  
Author(s):  
Tyler Gonzalez ◽  
Erica Fisk ◽  
Christopher Chiodo ◽  
Jeremy Smith ◽  
Eric M. Bluman
Keyword(s):  
Patient Satisfaction ◽  
Outpatient Surgery ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Ankle Arthroplasty ◽  
Proper Patient Selection ◽  
Estimated Blood Loss ◽  
Outpatient Group ◽  
Inpatient Group ◽  
Ed Visits

Background: Total ankle arthroplasty (TAA) is a rapidly growing treatment for end-stage ankle arthritis that is generally performed as an inpatient procedure. The feasibility of outpatient total ankle arthroplasty (OTAA) has not been reported in the literature. We sought to establish proof of concept for OTAA by comparing outpatient vs inpatient perioperative complications, postoperative emergency department (ED) visits, readmissions, patient satisfaction, and cost analysis. Methods: From July 2010 to September 2015, a total of 36 patients underwent TAA. Patients with prior ankle replacement, prior ankle infections, neuroarthropathy, or osteonecrosis of the talus were excluded from the study. All patient demographics, tourniquet times, estimated blood loss, comorbidities, concomitant procedures, complications, return ED visits, and readmissions were recorded. Patient satisfaction questionnaires were collected. Twenty-one patients had outpatient surgery and 15 had inpatient surgery. The cohorts were matched demographically. Results: The average length of stay for the inpatient group was 2.5 days. The overall cost differential between the groups was 13.4%, with the outpatient group being less costly. This correlates to a cost savings of nearly $2500 per case. One patient in the outpatient group had a return ED visit on postoperative day 1 for urinary retention. There were no 30-day readmissions in either group. Seventy-one percent of the outpatient group and 93% of the inpatient group would not change to a different postoperative admission status if they were to have the procedure again. Conclusion: Our results show that OTAA was a cost-effective and safe alternative with low complication rates and high patient satisfaction. With proper patient selection, OTAA was beneficial to both the patient and the health care system by driving down total cost. It has the capacity to generate substantial savings while providing equal or better value to the patient. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Does Gender Influence the Outcomes of Total Ankle Arthroplasty in Patients with Ankle Osteoarthritis?

2020 ◽  
Author(s):  
Gun-Woo Lee ◽  
Keun-Bae Lee
Keyword(s):  
Mobile Bearing ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Ankle Osteoarthritis ◽  
Ankle Arthroplasty ◽  
Gender Influence ◽  
Implant Survivorship ◽  
The Difference ◽  
American Orthopaedic

Abstract Background: Total ankle arthroplasty has progressed as a treatment option for patients with ankle osteoarthritis. However, no studies have been conducted to evaluate the effect of gender on the outcome. The purpose of the present study was to evaluate outcomes, survivorship, and complications rates of total ankle arthroplasty, according to gender differences. Methods: This study included 187 patients (195 ankles) that underwent mobile-bearing HINTEGRA prosthesis at a mean follow-up of 7.5 years (range, 4 to 14). The two groups consisted of a men’s group (106 patients, 109 ankles) and a women’s group (81 patients, 86 ankles). Average age was 64.4 years (range, 45 to 83). Results: Clinical scores on the Ankle Osteoarthritis Scale for pain and disability, and American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved and the difference was not statistically significant between the two groups at the final follow-up. There were no significant differences in complication rates and implant survivorship between the two groups. The overall survival rate was 96.4% in men and 93.4% in women at a mean follow-up of 7.5 years (p=0.621). Conclusions: Clinical outcomes, complication rates, and survivorship of total ankle arthroplasty were comparable between men and women. These results suggest that gender did not seem affect outcomes of total ankle arthroplasty in patients with ankle osteoarthritis.

Complication Rates Following Total Ankle Arthroplasty in Inpatient versus Outpatient Populations: A Systematic Review & Meta-Analysis

2021 ◽  
Vol 60 (1) ◽  
pp. 61-66
Author(s):  
Rachel H. Albright ◽  
Ryan J. Rodela ◽  
Panah Nabili ◽  
Chris E. Gentchos ◽  
N. Jake Summers
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Ankle Arthroplasty

Total ankle arthroplasty

2021 ◽  
Vol 103-B (4) ◽  
pp. 696-703
Author(s):  
Timothy M. Clough ◽  
Joseph Ring
Keyword(s):  
Survival Rates ◽  
Patient Reported Outcome Measures ◽  
Deep Infection ◽  
Patient Reported Outcome ◽  
Consecutive Series ◽  
Superficial Infection ◽  
Ankle Arthroplasty ◽  
Joint Registry ◽  
Patient Reported

Aims We report the medium-term outcomes of a consecutive series of 118 Zenith total ankle arthroplasties (TAAs) from a single, non-designer centre. Methods Between December 2010 and May 2016, 118 consecutive Zenith prostheses were implanted in 114 patients. Demographic, clinical, and patient-reported outcome measures (PROMs) data were collected. The endpoint of the study was failure of the implant requiring revision of one or all of the components. Kaplan-Meier survival curves were generated with 95% confidence intervals (CIs) and the rate of failure calculated for each year. Results Eight patients (ten ankles) died during follow-up, but none required revision. Of the surviving 106 patients (108 ankles: rheumatoid arthritis (RA), n = 15; osteoarthritis (OA), n = 93), 38 were women and 68 were men, with a mean age of 68.2 years (48 to 86) at the time of surgery. Mean follow-up was 5.1 years (2.1 to 9.0). A total of ten implants failed (8.5%), thus requiring revision. The implant survival at seven years, using revision as an endpoint, was 88.2% (95% CI 100% to 72.9%). There was a mean improvement in Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ) from 85.0 to 32.8 and visual analogue scale (VAS) scores from 7.0 to 3.2, and overall satisfaction was 89%. The three commonest complications were malleolar fracture (14.4%, n = 17), wound healing (13.6%, n = 16), and superficial infection (12.7%, n = 15). The commonest reason for revision was aseptic loosening. No patients in our study were revised for deep infection. Conclusion Our results show that Zenith survival rates are comparable with those in the literature for other implants and in the National Joint Registry (NJR). Overall patient satisfaction was high as were functional outcomes. However, the data highlight potential complications associated with this surgery. The authors believe that these figures support ankle arthroplasty as an option in the treatment of ankle arthritis. Cite this article: Bone Joint J 2021;103-B(4):696–703.

scholarly journals A 27-year Meta-analysis of Ankle Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0023 ◽  
Author(s):  
Christopher Gross ◽  
Steven Haddad ◽  
Jesse Morris ◽  
Elizabeth Durante ◽  
Philip Kirn
Keyword(s):  
Systematic Review ◽  
Second Generation ◽  
Revision Rate ◽  
Meta Analysis ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Third Generation ◽  
Early Generation ◽  
Previous Systematic Review ◽  
Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty is an alternative to ankle arthrodesis for the treatment of end-stage arthritis while maintaining greater ankle motion and functionality. Early generation implants had unacceptably high complication rates. However, increasing surgical experience and newer third-generation designs have the potential to offer better outcomes. A previous systematic review reported results from studies published between 1990 and 2005, focusing on second-generation implants. We performed a systematic review of the literature addressing the intermediate-long-term outcomes of interest in total ankle arthroplasty studies published since 2006, and we compared our findings to those from earlier generation implants. Methods: A comprehensive search of MEDLINE for all articles published from 3/25/2006 to 2/1/2017 was conducted with a minimum two-year follow-up. Two reviewers evaluated each study to determine whether it was eligible for inclusion and abstracted the data of interest. Meta-analytic pooling of group results across studies was performed. The analysis focused on third-generation ankle implants. Results: The previous systematic review identified 10 studies (n=852), whereas we identified 40 studies (n=4835). The prior study showed a five and ten-year survival rate of 78% and 77%, respectively; respective rates were 86% (p=0.001) and 76% (p=0.53) in ours and similar to the previous study. The revision rate following TAR was 7% in the earlier review (loosening/subsidence, 28%). In ours, the revision rate following TAR was 9.6% (p=0.10) (component loosening, 37%); 3.4% (p=0.02) of ankles were converted to arthrodesis. The mean post-operative Ankle-Hindfoot score was 78.2 points in the prior review and 80.1 (p=0.20) points for ours. There is significant (p<0.0001) heterogeneity (I2=92.94%) between the studies; a meta-analysis of proportions showed that 81.6%of subjects had good outcomes while 46.6% had an excellent outcome. Conclusion: Based on these findings, the outcomes for third-generation total ankle arthroplasty have no significant differences in survival rates when compared to second-generation implants. However, functional scores, range of motion, and overall patient outcomes were significantly higher in the third-generation implants. However, data from early generation studies were sparse in comparison, so direct comparative studies are needed to strengthen this conclusion.

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