SLR - March 2018 - Candice N. Cooper

Trends in Complication Rates Following Ankle Arthrodesis and Total Ankle Replacement

Reference: Starvrakis AI, SooHoo NF.  Trends in Complication Rates Following Ankle Arthrodesis and Total Ankle Replacement. J Bone Joint Surg Am.  Sep 7;98(17):1453–8.

Scientific Literature Review

Reviewed By: Candice N. Cooper, DPM
Residency Program: Hennepin County Medical Center, Minneapolis, MN

Podiatric Relevance: Ankle arthritis is a common condition seen and treated by foot and ankle surgeons. Historically, ankle arthrodesis has been the treatment of choice when conservative treatments fail. While ankle arthrodesis has good clinical results with regards to pain relief, there have been concerns about the loss of range of motion and development of arthritis in adjacent joints requiring further surgeries. Total ankle replacements preserve the range of motion to the ankle and therefore theoretically have a decreased risk of developing adjacent joint arthritis. This study aims at comparing short- and long-term complication rates of total ankle replacements compared with ankle arthrodesis.

Methods: A level III retrospective cohort study was performed on patients in California who had undergone a primary ankle arthrodesis or total ankle replacement while inpatient between the years of 1995–2010. Short-term outcomes were examined and included hospital readmission for any cause, death and readmission for seven common surgical complications: acute MI, pneumonia, sepsis, PE, mechanical complications, surgical site bleeding and periprosthetic joint or wound infection. Long-term outcomes were also examined, and these included rates of major revision surgery (arthrodesis or replacement), adjacent joint arthrodesis (STJ, triple, TMTJ), total knee replacement and BKA. Patients from 2005–2010 were compared to an earlier study from 1995–2004.

Results: 8,491 patients underwent ankle arthrodesis, and 1,280 underwent total ankle replacement during the observation period. Patients who had total ankle replacements were significantly older, 68.45 years compared with 65.60 years, more likely to be female, white and have Medicare or private health insurance. Patients who underwent total ankle replacement surgeries had a decreased rate of readmission and periprosthetic joint or wound infection.  There was no significant difference in the rate of the other six common surgical complications. Patients who underwent total ankle replacement surgeries also had a decreased rate of requiring STJ arthrodesis, salvage ankle arthrodesis or BKA. There was an increased risk of requiring revision ankle replacement procedures for those who underwent and initial total ankle replacement. There was no significant difference between the two groups for requiring a triple or TMTJ arthrodesis or total knee replacement. When comparing patients from 1995–2004 and 2005–2010, there are equivalent or decreased short-term complication rates with the later group.

Conclusions: The authors conclude that there are equivalent or lower short- and long-term complication rates associated with undergoing a total ankle replacement when compared with an ankle arthrodesis. The risk of short-term complications associated with total ankle replacement has decreased overtime, making it a safe alternative to ankle arthrodesis when treating ankle arthritis. There were a number of limitations with this study, including information available in administrative databases, inclusion of only inpatient admissions, selection bias and length of postprocedure follow-up.  

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