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Fa-Binefa M, López-Hervás S, López-Capdevila L, Fernández de Retana P, Schon L. Survival and complications of transfibular trabecular metal total ankle replacement - A systematic review. Foot Ankle Surg 2024; 30:612-617. [PMID: 38821820 DOI: 10.1016/j.fas.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/06/2024] [Accepted: 05/13/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND In the past decade, the transfibular approach to Total Ankle Replacement (TAR) has emerged as an alternative to anterior approach with reduced bone resection. The purpose of this systematic review is to report survival, complications, and reoperation rates of transfibular TAR. METHODS We conducted a systematic search of studies that evaluated complications, reoperations, and survival of transfibular TAR following PRISMA guidelines across PubMed, Scopus and Web of Science. RESULTS Our review included data from 12 cohorts, comprising 919 patients across 7 countries, with an average age of 62 years (59% posttraumatic). Over an average follow-up period of 3 years, adverse events occurred in 23% of cases, with 18% requiring surgical reintervention, mostly due to hardware removal. The survival rate of the transfibular TAR metal components was 97% at the final follow-up. CONCLUSION Transfibular TAR demonstrates a 97% survival rate at a 3-year follow-up. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Manel Fa-Binefa
- Hospital de la Santa Creu i Sant Pau. Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Universitat Autònoma de Barcelona, Spain
| | - Sergio López-Hervás
- Hospital de la Santa Creu i Sant Pau. Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Laia López-Capdevila
- Hospital de la Santa Creu i Sant Pau. Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Pablo Fernández de Retana
- Hospital de la Santa Creu i Sant Pau. Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Lew Schon
- Institute for Foot and Ankle Reconstruction, Baltimore, MD, USA
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Kostuj T, Hönning A, Mittelmeier W, Malzahn J, H Baums M, Osmanski-Zenk K. Outcome after total ankle replacement or ankle arthrodesis in end-stage ankle osteoarthritis on the basis of german-wide data: a retrospective comparative study over 10 years. BMC Musculoskelet Disord 2024; 25:492. [PMID: 38918769 PMCID: PMC11197266 DOI: 10.1186/s12891-024-07612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 06/18/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND In symptomatic end-stage osteoarthritis of the ankle joint, total ankle replacement and ankle arthrodesis are the two primary surgical options for patients for whom conservative treatment fails. Published revision rates are often biased and difficult to compare. In this study, unplanned reoperation rates and revision rates were determined for both surgical interventions based on a large dataset, and risk factors for unplanned reoperations were identified. METHODS German-wide health data of the largest German health-care insurance carrier between 2001 and 2012 were retrospectively analyzed, and unplanned reoperation rates within 10 years were determined for index surgeries conducted in 2001 and 2002. Unplanned reoperation rates within 5 years for index surgeries conducted in 2001/2002 were compared to index surgeries conducted in 2006/2007. Multivariate logistic regression was used to identify risk factors for unplanned reoperations. RESULTS After ankle arthrodesis, 19% (95% confidence interval [CI], 16-22%) of 741 patients needed to undergo an unplanned reoperation within ten years. After total ankle replacement, the unplanned reoperation rate was 38% [95% CI, 29-48%] among 172 patients. For initial surgeries conducted at a later date, unplanned reoperation rates within five years were 21% [95% CI, 19-24%] for 1,168 ankle arthrodesis patients and 23% [95% CI, 19-28%] for 561 total ankle replacement patients. Significant risk factors for unplanned reoperations after ankle arthrodesis in the initial cohort were age < 50 years (odds ratio [OR] = 4.65 [95% CI 1.10;19.56]) and osteoporosis (OR = 3.72 [95% CI, 1.06;13.11]); after total ankle replacement, they were osteoporosis (OR = 2.96 [95% CI, 1.65;5.31]), Patient Clinical Complexity Level (PCCL) grade 3 (OR = 2.19 [95% CI, 1.19;4.03]), PCCL grade 4 (OR = 2.51 [95% CI, 1.22;5.17]) and diabetes mellitus (OR = 2.48 [95% CI, 1.33;4.66]). Kaplan-Meier analyses including 1,525 ankle arthrodesis patients and 644 total ankle replacement patients revealed an average unplanned reoperation-free time of approximately 17 years for both procedures. CONCLUSIONS Similar revision rates and unplanned reoperation rates for both procedures in the later-date cohort can likely be attributed to a learning curve for surgeons as well as advances in implant design. This analysis of billing health insurance data supports an increase in total ankle replacement surgeries.
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Affiliation(s)
- Tanja Kostuj
- Orthopädisch-Traumatologisches Zentrum, St. Marien-Hospital Hamm, Nassauerstraße 13-19, 59065, Hamm, Germany.
| | - Alexander Hönning
- Zentrum für Klinische Forschung, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Wolfram Mittelmeier
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
| | | | - Mike H Baums
- Fachbereich Orthopädie, Katholisches Klinikum Ruhrgebiet Nord (KKRN), Unfallchirurgie und Sporttraumatologie, Dorsten, Germany
| | - Katrin Osmanski-Zenk
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
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González-Alonso M, Trapote-Cubillas AR, Madera-González FJ, Fernández-Hernández Ó, Sánchez-Lázaro JA. Fixed-bearing versus mobile-bearing total ankle replacement survivorship. A meta-analysis. Foot Ankle Surg 2024; 30:275-284. [PMID: 38388212 DOI: 10.1016/j.fas.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 01/03/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Main objective of this research is to know if there is a different survival rate between fixed bearing (FB) and mobile bearing (MB) total ankle replacement (TAR). We hypothesized that there are no differences between the survival rates of both implants. METHODS A systematic search was performed in PubMed, Cochrane, EMBASE and ClinicalTrials.gov databases to identify published studies from August 2018 to September 2022 including results for FB and MB TAR survivorship. Inclusion criteria included 1) primary TAR in one or both feet in which implant could be identified, 2) a minimum of 20 procedures reported, 3) reported implant survivorship or calculable and 4) a minimum of 12 months follow-up for level 1-3 studies or 60 months for level 4 studies. RESULTS 3902 ankles in 28 studies were included. 719 were FB and 3104 MB with an overall survivorship of 94% (95% CI [0.89; 0.97]) and 89% (95% CI [0.86; 0.92]) respectively. After subgroup analysis, we did not find differences among both groups (p = 0.429). Meta-regression analysis showed that longer follow-up was associated with lower survival rates in MB group (p = 0.000) while no other relationships were found with other factors (age, level of evidence or conflict of interests). CONCLUSIONS No differences in survival rates between both groups were found. Age and other studied confounders were not found to be related with implant survivorship. However, longer follow-up was found to be related with lower survival rates. Studies with longer follow-up and higher level of evidence are needed to confirm results. LEVEL OF EVIDENCE IV, systematic review of level I to IV studies.
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Affiliation(s)
- Marcos González-Alonso
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, University Hospital of Leon, Leon 24008, Spain.
| | - Ana R Trapote-Cubillas
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, University Hospital of Leon, Leon 24008, Spain
| | - Francisco J Madera-González
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, University Hospital of Leon, Leon 24008, Spain
| | - Óscar Fernández-Hernández
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, University Hospital of Leon, Leon 24008, Spain; University of Salamanca, 37007 Salamanca, Spain
| | - Jaime A Sánchez-Lázaro
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, University Hospital of Leon, Leon 24008, Spain; University of Salamanca, 37007 Salamanca, Spain; Institute of Biomedicine (IBIOMED), University of Leon, 24071 Leon, Spain
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Altomare D, Di Matteo B, Kon E. Conservative Treatment for Ankle Cartilage: Cellular and Acellular Therapies: A Systematic Review. Foot Ankle Clin 2024; 29:253-263. [PMID: 38679437 DOI: 10.1016/j.fcl.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Biological agents like growth factors (ie, platelet rich plasma) and mesenchymal stem cells are rising in popularity among orthopedics. Orthobiologics therapy aims to fill the gap between conventional conservative therapies like hyaluronic acid and surgery, especially for cartilage disease. Ankle cartilage defects are very symptomatic and could lead to a severe decrease of quality of life in patients, because of pain, swelling, and inability to walk without pain. In this scenario, this paper aims to systematically review the current literature available about biological therapies for ankle cartilage.
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Affiliation(s)
- Daniele Altomare
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan 20090, Italy; Department of Orthopaedics and Traumatology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan 20089, Italy.
| | - Berardo Di Matteo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan 20090, Italy; Department of Orthopaedics and Traumatology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan 20089, Italy; Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov University, Moscow, 119991, Russia
| | - Elizaveta Kon
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan 20090, Italy; Department of Orthopaedics and Traumatology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan 20089, Italy; Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov University, Moscow, 119991, Russia
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5
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Usuelli FG, Maccario C, Indino C. Outcomes of Lateral Transfibular Approach for Total Ankle Replacement. Foot Ankle Clin 2024; 29:69-80. [PMID: 38309804 DOI: 10.1016/j.fcl.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Total ankle replacement through a lateral transfibular approach with trabecular metal implants was introduced in 2012 and originally was advertised as a safer approach in terms of wound healing issues. Further studies showed no significant difference comparing anterior and lateral approach for infections and would healing issues, whereas the main advantage is deformity correction, acting on coronal, sagittal, and rotational deformities and on fibular length issues. It showed a survival rate of 97.7% at 5 years follow-up.
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Affiliation(s)
- Federico G Usuelli
- Ortopedia della Caviglia e del Piede, Humanitas San Pio X, Via Francesco Nava, 31, Milan 20159, Italy.
| | - Camilla Maccario
- Ortopedia della Caviglia e del Piede, Humanitas San Pio X, Via Francesco Nava, 31, Milan 20159, Italy
| | - Cristian Indino
- Ortopedia della Caviglia e del Piede, Humanitas San Pio X, Via Francesco Nava, 31, Milan 20159, Italy
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Rodriguez-Merchan EC, Moracia-Ochagavia I. Results of Total Ankle Arthroplasty Versus Ankle Arthrodesis. Foot Ankle Clin 2024; 29:27-52. [PMID: 38309802 DOI: 10.1016/j.fcl.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
No differences have been found between total ankle arthroplasty (TAA) and ankle arthrodesis (AA) with respect to patient-reported outcome measures (PROMs), although both interventions were shown to improve PROMs with respect to the preoperative situation. That is, both interventions (AA and TAA) were effective in improving preoperative symptoms. On the other hand, 2-year complication rates were higher after AA (27%) than after TAA (16%); however, infection rates were similar (4%). The published revision rate after AA is 16% versus 11% after TAA. In short, TAA and AA appear to offer the same PROMs, but TAA has a lower rate of complications (except for infection) and revisions.
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Affiliation(s)
| | - Inmaculada Moracia-Ochagavia
- Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Paseo de la Castellana 261, 28046-Madrid, Spain
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7
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Arshad Z, Haq II, Bhatia M. Learning curve of total ankle arthroplasty: a systematic review. Arch Orthop Trauma Surg 2024; 144:591-600. [PMID: 37917408 DOI: 10.1007/s00402-023-05064-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/03/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Together with ankle arthrodesis, total ankle arthroplasty is now accepted as a first-line intervention in the management of end-stage arthritis of the ankle. The evidence regarding how outcomes are affected by surgeon experience is inconsistent; we performed a systematic review to evaluate the effect of a learning curve in total ankle arthroplasty outcomes. METHODS An electronic database search was performed in PubMed, Embase, ISI Web of Science and Cochrane trials. Two reviewers independently conducted a two-stage title/abstract and full text screening. English-language original research studies comparing patient-reported outcome measures (PROMs), complication/revision rates, operative time, length of stay or radiation exposure according to surgeon experience were included. Quality assessment was performed using the methodological index for non-randomised studies. RESULTS All but one included study report either improved PROMs, reduced complication/revision rate, reduced hospital stay length/operative time or reduced radiation exposure with increasing surgeon experience. However, the majority of these findings lack statistical significance. Two studies assessing the plateau of the learning curve report a wide range of plateau thresholds between 9 and 39 cases. CONCLUSION This review finds a largely non-significant trend towards improvements in PROMs, complication, and revision rates with improved surgeon experience. The lack of statistical significance in a number of studies may be partially explained by methodological flaws, with more suitably designed studies reporting significant improvements. Future research into the effect of advancements in implant design and insertion guides is required to further characterise the magnitude of the learning curve and guide both mitigation and learning strategies.
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Affiliation(s)
- Zaki Arshad
- Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, LE1 5WW, UK.
| | - Ibrahim Inzarul Haq
- Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, LE1 5WW, UK
| | - Maneesh Bhatia
- Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, LE1 5WW, UK
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8
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Townshend D, Bing A, Blundell C, Clough T, Davenport J, Davies H, Davis J, Dhar S, Hepple S, Kakwani R, Karski M, Makwana N, McKinley J, Murty A, Raglan M, Shalaby H, Sharpe I, Smith R, Taylor H, Goldberg A. Two to Five-Year Outcomes of Total Ankle Arthroplasty with the Infinity Fixed-Bearing Implant: A Concise Follow-up of a Previous Report. J Bone Joint Surg Am 2023; 105:1846-1856. [PMID: 38063779 PMCID: PMC10695343 DOI: 10.2106/jbjs.22.01294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- David Townshend
- Northumbria NHS Healthcare Trust, North Shields, England, United Kingdom
| | - Andrew Bing
- Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, England, United Kingdom
| | | | - Tim Clough
- Wrightington Hospital, Wrightington, United Kingdom
| | | | - Howard Davies
- Northern General Hospital, Sheffield, United Kingdom
| | | | - Sunil Dhar
- Nottingham University Hospitals Trust, Nottingham, United Kingdom
| | - Steve Hepple
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom
| | - Rajesh Kakwani
- Northumbria NHS Healthcare Trust, North Shields, England, United Kingdom
| | - Mike Karski
- Wrightington Hospital, Wrightington, United Kingdom
| | - Nilesh Makwana
- Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, England, United Kingdom
| | | | - Aradhyula Murty
- Northumbria NHS Healthcare Trust, North Shields, England, United Kingdom
| | - Martin Raglan
- Nottingham University Hospitals Trust, Nottingham, United Kingdom
| | | | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Robert Smith
- Wrightington Hospital, Wrightington, United Kingdom
| | - Heath Taylor
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
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9
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Haddad FS. The power of the media. Bone Joint J 2023; 105-B:1031-1032. [PMID: 37777200 DOI: 10.1302/0301-620x.105b10.bjj-2023-0883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Fares S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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10
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Yasui T, Higuchi J, Kasai T, Yamada A, Kobata T, Hasebe K, Hara M. Association of Preoperative Depression Score With Outcomes of Transfibular Total Ankle Arthroplasty. J Foot Ankle Surg 2023; 62:807-811. [PMID: 37086907 DOI: 10.1053/j.jfas.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023]
Abstract
Favorable short-term results of transfibular total ankle arthroplasty have been reported in several studies; however, the factors affecting these results have not been elucidated. This study aimed to determine whether preoperative depression affects the outcome of transfibular total ankle arthroplasty and whether depression changes with surgery. Scores from the Japanese Society of Surgery of the Foot Ankle/Hindfoot scale (JSSF scale), Self-Administered Foot Evaluation Questionnaire (SAFE-Q), Hospital Anxiety and Depression Scale (HADS), and Timed Up & Go test (TUG) were collected preoperatively, at 6 months, and at 1 year postoperatively from 20 patients. Eighteen patients were diagnosed with osteoarthritis and 2 patients with rheumatoid arthritis. The mean age of the patients was 75 years. Patients were divided into 2 groups: those with preoperative HADS depression scores above the median (higher depression score group) and below the median (lower depression score group), and intergroup comparisons were made. No significant differences were observed in the JSSF and TUG scores between the groups, both preoperatively and postoperatively. Meanwhile, the SAFE-Q pain subscale score was significantly lower in the higher depression score group than in the lower depression score group (median, 59 vs 90) 1 year postoperatively. There were no differences in the other SAFE-Q subscale scores between the groups. The results suggested that depressive tendencies did not affect postoperative functional results using objective assessment measures but had a negative impact on pain in subjective assessment measures.
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Affiliation(s)
- Tetsuro Yasui
- Department of Orthopaedic Surgery, Teikyo University Mizunokuchi Hospital, Kawasaki-shi, Kanagawa, Japan.
| | - Junya Higuchi
- Department of Orthopaedic Surgery, Teikyo University Mizunokuchi Hospital, Kawasaki-shi, Kanagawa, Japan
| | - Taro Kasai
- Department of Orthopaedic Surgery, Teikyo University Mizunokuchi Hospital, Kawasaki-shi, Kanagawa, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Atsuhisa Yamada
- Department of Orthopaedic Surgery, Teikyo University Mizunokuchi Hospital, Kawasaki-shi, Kanagawa, Japan
| | - Tomohiro Kobata
- Department of Rehabilitation Medicine, Teikyo University Mizonokuchi Hospital, Kawasaki-shi, Kanagawa, Japan
| | - Kiyotaka Hasebe
- Department of Rehabilitation Medicine, Teikyo University Mizonokuchi Hospital, Kawasaki-shi, Kanagawa, Japan
| | - Motohiko Hara
- Department of Rehabilitation, Teikyo University Mizonokuchi Hospital, Kawasaki-shi, Kanagawa, Japan
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11
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Zhang Z, Chien BY, Noori N, Day J, Robertson C, Schon L. Application of the Mayo Periprosthetic Joint Infection Risk Score for Total Ankle Arthroplasty. Foot Ankle Int 2023; 44:451-458. [PMID: 36946575 DOI: 10.1177/10711007231157697] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Assessing patient's risk of infection is fundamental for prevention of periprosthetic joint infection (PJI) after total ankle arthroplasty (TAA). The Mayo Prosthetic Joint Infection Risk Score (Mayo Score) is based on data from total hip and knee arthroplasty and has not been validated for application for TAA. METHODS A total of 405 consecutive TAA cases were followed for 6 months for PJI. Individual patients' Mayo Scores were calculated and analyzed with logistic regression and receiver operating characteristic (ROC) for predictability for PJI. A critical cut-off Mayo Score for patients at high risk of PJI was determined by best Youden index. Among the Mayo Score-defined high-risk patients, the contribution of different risk factors were compared between the PJI and non-PJI patients. RESULTS There were 10 cases of PJI (2.5%) among the 405 cases within 6 months after TAA. Of the 405 patients, the Mayo Scores ranged between -4 and 13 (median 2; interquartile range 0-5). The average Mayo Score was 2.5 ± 3.4 in the non-PJI patients and 7.7 ± 3.1 in the PJI patients (P < .001). Logistic regression showed that the probability of PJI increased with higher Mayo Scores (odds ratio 1.48, 95% CI 1.23-1.78). All but 1 PJI patients had a Mayo Score >5. The sensitivity and specificity were 90.0% and 84.3%, respectively, when a Mayo Score >5 was used as a criterion for high risk of PJI. CONCLUSION This study demonstrated that the Mayo Score could similarly predict PJI risk after TAA as in total hip and knee arthroplasty. Data analysis suggests that a Mayo Score >5 could be a criterion for identifying high-risk patients for PJI, although further validation with a large number of PJI cases is necessary. LEVEL OF EVIDENCE II, developing diagnositic criteria with consecutive cases.
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Affiliation(s)
- Zijun Zhang
- Center for Orthopaedic Innovation, Mercy Medical Center, Baltimore, MD, USA
| | - Bonnie Y Chien
- Department of Orthopaedic Surgery, Columbia University, New York, NY, USA
| | - Naudereh Noori
- Department of Orthopaedic Surgery, University of California, Irvine, CA, USA
| | - Jonathan Day
- Department of Orthopaedic Surgery, Georgetown University, Washington, DC, USA
| | - Cassandra Robertson
- Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
| | - Lew Schon
- Center for Orthopaedic Innovation, Mercy Medical Center, Baltimore, MD, USA
- Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
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12
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Hembree WC, Tarka MC, Pasternack JB, Mathew SE, Guyton GP. What's New in Foot and Ankle Surgery. J Bone Joint Surg Am 2023; 105:737-743. [PMID: 36888693 DOI: 10.2106/jbjs.22.01382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
- Walter C Hembree
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
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13
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Abstract
Despite the increasing numbers of ankle arthroplasties, there are limited studies on their survival and comparisons between different implants. The primary aim of this study was to determine the failure rates of primary ankle arthroplasties commonly used in the UK. A data linkage study combined National Joint Registry (NJR) data and NHS Digital data. The primary outcome of failure was defined as the removal or exchange of any components of the implanted device. Life tables and Kaplan-Meier survival charts were used to illustrate survivorship. Cox proportional hazards regression models were fitted to compare failure rates between 1 April 2010 and 31 December 2018. Overall, 5,562 primary ankle arthroplasties were recorded in the NJR. Linked data show a one-year survivorship of 98.8% (95% confidence interval (CI) 98.4% to 99.0%), five-year survival in 2,725 patients of 90.2% (95% CI 89.2% to 91.1%), and ten-year survival in 199 patients of 86.2% (95% CI 84.6% to 87.6%). The five-year survival for fixed-bearing implants was 94.3% (95% CI 91.3% to 96.3%) compared to 89.4% (95% CI 88.3% to 90.4%) for mobile-bearing implants. A Cox regression model for all implants with over 100 implantations using the implant with the best survivorship (Infinity) as the reference, only the STAR (hazard ratio (HR) 1.60 (95% CI 0.87 to 2.96)) and INBONE (HR 0.38 (95% CI 0.05 to 2.84)) did not demonstrate worse survival at three and five years. Ankle arthroplasties in the UK have a five-year survival rate of 90.2%, which is lower than recorded on the NJR, because we have shown that approximately one-third of ankle arthroplasty failures are not reported to the NJR. There are statistically significant differences in survival between different implants. Fixed-bearing implants appear to demonstrate higher survivorship than mobile-bearing implants.
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Affiliation(s)
- Toby Jennison
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | | | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andrew J Goldberg
- Wellington Hospital, London, UK.,UCL Division of Surgery, Royal Free Hospital, London, UK.,Imperial College London, London, UK
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