James Randolph Onggo1, Mithun Nambiar2, Kevin Phan3, Benjamin Hickey4, Michael Galvin5, Harvinder Bedi6. 1. Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria 3128, Australia. Electronic address: jamesonggo1993@hotmail.com. 2. Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria 3128, Australia; Department of Surgery, The University of Melbourne, Parkville, Victoria 3010, Australia. Electronic address: mithunnambiar1@gmail.com. 3. NeuroSpine Surgery Research Group, The Prince of Wales Private Hospital, 320-346 Barker St, Randwick, New South Wales 2031, Australia. Electronic address: kphan.vc@gmail.com. 4. Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria 3128, Australia; Wrexham Maelor Hospital, Croesnewydd Rd, Wrexham, Wales LL13 7TD, UK. Electronic address: drhickey@hotmail.co.uk. 5. Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria 3128, Australia. Electronic address: galvin.michael@me.com. 6. Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria 3128, Australia. Electronic address: hsbedi1@bigpond.com.
Abstract
BACKGROUND: Total ankle arthroplasty (TAA) is increasingly gaining recognition as an alternative to ankle arthrodesis in the treatment of end-stage ankle arthritis. Despite high rates of adverse events during early inception, newer generations of uncemented prosthesis and design modifications have improved outcomes. Questions remain regarding the long-term outcomes and implant survivorship of TAA. AIM: This analysis aims to establish an updated review of intermediate and long-term clinical outcome and complication profile of TAA. PATIENTS AND METHODS: A multi database search was performed on 14th October 2018 according to PRISMA guidelines. All articles that involved patients undergoing uncemented TAA with 5 years minimum follow-up, reported clinical outcome or complication profile of TAA were included. Seventeen observational studies were included in the review, with 1127 and 262 ankles in the 5 and 10 years minimum follow-up groups respectively. RESULTS: Mean difference between pre- and post-operative AOFAS score was 43.60 (95%CI: 37.51-49.69, p<0.001) at 5 years minimum follow-up. At 5 years minimum follow-up, pooled proportion (PP) of prostheses revision for any reason other than polyethylene exchange was 0.122 (95%CI: 0.084-0.173), all cause revision was 0.185 (95%CI: 0.131-0.256), unplanned reoperation was 0.288 (95%CI: 0.204-0.390) and all infection was 0.033 (95%CI: 0.021-0.051). At 10 years minimum follow-up, PP of prostheses revision for any reason other than polyethylene exchange was 0.202 (95%CI: 0.118-0.325), all cause revision was 0.305 (95%CI: 0.191-0.448), unplanned reoperation was 0.422 (95%CI: 0.260-0.603) and all infection was 0.029 (95%CI: 0.013-0.066). CONCLUSION: Despite good intermediate and long-term functional outcome measures, TAA has relatively higher revision surgery prevalence with longer follow-up periods. Further research should be directed towards identifying patient populations that would best benefit from TAA and those at greatest risk of requiring revision surgery.
BACKGROUND: Total ankle arthroplasty (TAA) is increasingly gaining recognition as an alternative to ankle arthrodesis in the treatment of end-stage ankle arthritis. Despite high rates of adverse events during early inception, newer generations of uncemented prosthesis and design modifications have improved outcomes. Questions remain regarding the long-term outcomes and implant survivorship of TAA. AIM: This analysis aims to establish an updated review of intermediate and long-term clinical outcome and complication profile of TAA. PATIENTS AND METHODS: A multi database search was performed on 14th October 2018 according to PRISMA guidelines. All articles that involved patients undergoing uncemented TAA with 5 years minimum follow-up, reported clinical outcome or complication profile of TAA were included. Seventeen observational studies were included in the review, with 1127 and 262 ankles in the 5 and 10 years minimum follow-up groups respectively. RESULTS: Mean difference between pre- and post-operative AOFAS score was 43.60 (95%CI: 37.51-49.69, p<0.001) at 5 years minimum follow-up. At 5 years minimum follow-up, pooled proportion (PP) of prostheses revision for any reason other than polyethylene exchange was 0.122 (95%CI: 0.084-0.173), all cause revision was 0.185 (95%CI: 0.131-0.256), unplanned reoperation was 0.288 (95%CI: 0.204-0.390) and all infection was 0.033 (95%CI: 0.021-0.051). At 10 years minimum follow-up, PP of prostheses revision for any reason other than polyethylene exchange was 0.202 (95%CI: 0.118-0.325), all cause revision was 0.305 (95%CI: 0.191-0.448), unplanned reoperation was 0.422 (95%CI: 0.260-0.603) and all infection was 0.029 (95%CI: 0.013-0.066). CONCLUSION: Despite good intermediate and long-term functional outcome measures, TAA has relatively higher revision surgery prevalence with longer follow-up periods. Further research should be directed towards identifying patient populations that would best benefit from TAA and those at greatest risk of requiring revision surgery.
Authors: C Stadler; M Stöbich; B Ruhs; C Kaufmann; L Pisecky; S Stevoska; T Gotterbarm; M C Klotz Journal: Arch Orthop Trauma Surg Date: 2021-06-04 Impact factor: 3.067