SLR - September 2020 - Jason Hymowitz

Effect of Age on Outcome and Revision in Total Ankle Arthroplasty

Reference: Gaugler, M, Krahenbuhl, N, Barg, A, Ruiz, R, Horn-Lang, T, Susdorf, R, Dutilh, G, Hintermann, B. Effect of Age on Outcome and Revision in Total Ankle Arthroplasty. The Bone & Joint Journal. 2020 Jun 30.

Scientific Literature Review 

Reviewed By: Jason Hymowitz, DPM
Residency Program: Hoboken University Medical Center – Hoboken, NJ

Podiatric Relevance: The total ankle arthroplasty is gaining popularity in the podiatric landscape of ankle arthritis, instability, and chronic pain. There are several factors that influence the decision to either go forward with the procedure or to try other either conservative management or other joint salvage/destructive procedures, one of which is Age a topic of debate in literature and between surgeons as it relates to total ankle arthroplasty. The longevity of the novel and advanced devices as it relates to the patients’ improvement in every day activity and long term success of surgery is unknown. This study looks at the difference in outcomes and revisions of Hintegra total ankle implants between “young” and “old” patients.

Methods: This study was a retrospective cohort of 789 patients with end stage ankle osteoarthritis who received a Hintegra total ankle implant. Hindfoot score (AOFAS) and VAS pain scale was used to provide clinical assessment and were performed preoperatively, three and six months postoperatively, and then annually. Revision surgeries were categorized into minor and major. Minor included any revision not involving metal exchange and major categorized exchange of the metal implant or complete removal and subsequent arthrodesis. Patients were separated into young and old with specific age limits detailing each group, for example less than or equal to 50 versus greater than 55. Patients were further grouped into sex, etiology of osteoarthritis, and history of ankle trauma. Surgical steps during the surgery were categorized as well. 

Results: There was a significant difference in etiology of osteoarthritis between age groups with higher primary OA in the older group. Age had no effect or significance on improvement in AOFAS hindfoot scores from preoperative to postoperative values. Preoperative hindfoot and pain scores had impact on levels of improvement in clinical outcomes. Men improved by a higher percentage than women in clinical assessments. Ankles with post traumatic OA improved greater compared to secondary OA. The mean follow up time was 5.4 years for minor revision patients and 6.9 years for major revision. The outcomes revealed slightly greater pain relief in the older population. 

Conclusions: In this study, the authors reveal that the age of the patient did not greatly affect the outcome of the total ankle arthroplasty. Follow up time was significant and gives strong evidence that the TAA is a powerful and successful procedure when compared to older and younger population. It also gives further evidence to the success of the procedure based on the etiology of the ankle OA which can give both surgeons and candidates for the procedure a look into the course of the treatment and potential follow up outcomes. Limitations for the study include the use of the specific clinical outcome measures that are not a validated score and that the procedures were all performed by one specific surgeon. The procedure has a learning curve and experience has a strong effect on the results. Studies with more specific measurements and with other surgeons performing the TAA should be performed in the future.

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