SLR - April 2021 - Cody T. Gaupel

Analysis of Early Failure Rate and Its Risk Factor with 2157 Total Ankle Replacements

Reference: Lee, J.W., Im, WY., Song, S.Y. et al. Analysis of Early Failure Rate and Its Risk Factor With 2157 Total Ankle Replacements. Sci Rep 11, 1901 (2021).

Level of Evidence: III 

Scientific Literature Review

Reviewed By: Cody T. Gaupel, DPM
Residency Program: Christus St. Patrick’s Hospital – Lake Charles, LA

Podiatric Relevance: Total ankle arthroplasty (TAA) has increased in popularity in the 21st century with development of newer generation implants with increased longevity when compared to previous generation implants. However, TAA still presents with a higher prevalence of failure compared to larger joint arthroplasty such as hip and knee. The authors set out to calculate the failure rate within five years of TAA with a defined characteristic of revision arthroplasty or removal and conversion to arthrodesis. They seek to identify what risk factors may contribute to early implant failure. Research of this magnitude is important for identifying the optimal patient procedure selection to improve surgical outcomes. 

Methods: This retrospective cohort study utilized the South Korean National Health Insurance database to review the entire single healthcare South Korean population for patient records who underwent TAA from 1/2007-11/2016. Patient’s were included if they had a minimum one year follow up and surgery was unilateral. Failure was defined as requiring revision TAA within five years, or implant removal with conversion to arthrodesis within five years. Covariables included were sex, age, hospital admission, duration and comorbidities. Specific comorbidities of focus consisted of diabetes, congestive heart failure, history of myocardial infarction, hypertension, cerebrovascular disease, peripheral vascular disease, chronic pulmonary disease, renal failure, hyperlipidemia, rheumatoid arthritis, dementia, psychosis, alcohol use, depression and osteoporosis. These variables were analyzed specifically between the “failure” and “no failure” groups using chi-square and independent samples t-test to set a p-value of < 0.05 to note significance between the two groups.

Results: Two thousand one hundred fifty-seven patients were included for analysis. One thousand nine hundred sixty implants survived the five-year follow up period, while a total of 197 (9.1 percent) patients suffered implant failure within five years. Of these, 165 received revision TAA and 32 were converted to ankle arthrodesis. Statistically significant differences between the two outcome groups and leading to early failure were noted to be chronic pulmonary disease, diabetes, PVD, dementia, hyperlipidemia and alcohol abuse. Of those, the highest risk factors associated with early failure were dementia, followed by chronic pulmonary disease and diabetes.

Conclusions: Identifying patient comorbidities and risks factors associated with early TAA failure is imperative in the surgical decision making process and the preoperative patient education discussion. Dementia, chronic pulmonary disease, and diabetes carry higher risk factors for early failure as identified in this study. Although not clearly described, the study mentioned primary use of Hintegra® and Salto Talaris® implants in Korea, therefore, the results are not all-inclusive of TAA’s. However, the study still provides adequate insight for considering patient selection to optimize patient outcomes, expectations and satisfaction when undergoing TAA surgery. Further research needs to be performed to provide better evidence, but this study enhances clinical knowledge in the surgical selection process. 

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