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Wu KA, Anastasio AT, Krez AN, O'Neill C, Adams SB, DeOrio JK, Easley ME, Nunley JA. Diabetic management and infection risk in total ankle arthroplasty. Foot Ankle Surg 2024; 30:552-556. [PMID: 38637171 DOI: 10.1016/j.fas.2024.04.008] [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: 01/09/2024] [Revised: 03/11/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND As total ankle arthroplasty (TAA) increases in popularity nationwide for the management of end-stage arthritis, it is essential to understand ways to mitigate the risk of infection. Diabetes increases the risk of infection due to compromised immunity and impaired wound-healing mechanisms. However, there is limited research on how diabetic management, inclusive of medications and glucose control, may impact infection risks post-TAA. This study aims to demonstrate the impact of diabetic management on the occurrence of periprosthetic joint infection (PJI) following TAA. METHODS This was a retrospective study of patients who underwent a TAA at a single academic institution from March 2002 to May 2022. Patients with diabetes who developed an intraarticular infection following TAA were propensity score matched (1:3) to diabetic patients who did not. Data collection included demographics, implant types, diabetic medications, and preoperative hemoglobin A1c. PJI was diagnosed based on Musculoskeletal Infection Society (MSIS) criteria. Statistical analyses assessed differences in medication use, glucose control, and infection rates between groups. RESULTS Of the 1863 patients who underwent TAA, 177 patients had a diagnosis of diabetes. The infection rate in patients with diabetes (2.8%) was higher than the total cohort rate (0.8%). Five patients with diabetes developed a PJI at an average of 2.2 months postoperatively. This cohort (n = 5) was compared to propensity score-matched controls (n = 15). There was no significant difference in diabetic medication use. Patients who developed PJI had higher rates of uncontrolled diabetes (60.0% vs. 6.7%) and average A1c levels (7.02% vs. 6.29%) compared to controls. CONCLUSION Our findings suggest that the elevated risk of PJI observed in individuals with diabetes subsequent to TAA may be attributed not solely to the presence of diabetes, but to inadequate glycemic control. Effectively managing blood glucose levels is imperative for achieving favorable outcomes following TAA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kevin A Wu
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Albert T Anastasio
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Alexandra N Krez
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Conor O'Neill
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Samuel B Adams
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
| | - James K DeOrio
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Mark E Easley
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
| | - James A Nunley
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
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2
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Fritz J, Rashidi A, de Cesar Netto C. Magnetic Resonance Imaging of Total Ankle Arthroplasty: State-of-The-Art Assessment of Implant-Related Pain and Dysfunction. Clin Podiatr Med Surg 2024; 41:619-647. [PMID: 39237176 DOI: 10.1016/j.cpm.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
Total ankle arthroplasty (TAA) is an effective alternative for treating patients with end-stage ankle degeneration, improving mobility, and providing pain relief. Implant survivorship is constantly improving; however, complications occur. Many causes of pain and dysfunction after total ankle arthroplasty can be diagnosed accurately with clinical examination, laboratory, radiography, and computer tomography. However, when there are no or inconclusive imaging findings, magnetic resonance imaging (MRI) is highly accurate in identifying and characterizing bone resorption, osteolysis, infection, osseous stress reactions, nondisplaced fractures, polyethylene damage, nerve injuries and neuropathies, as well as tendon and ligament tears. Multiple vendors offer effective, clinically available MRI techniques for metal artifact reduction MRI of total ankle arthroplasty. This article reviews the MRI appearances of common TAA implant systems, clinically available techniques and protocols for metal artifact reduction MRI of TAA implants, and the MRI appearances of a broad spectrum of TAA-related complications.
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Affiliation(s)
- Jan Fritz
- Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, Duke University, Durham, NC, USA.
| | - Ali Rashidi
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, 3rd Floor, Rm 313, New York, NY 10016, USA
| | - Cesar de Cesar Netto
- Department of Radiology, Molecular Imaging Program at StanDepartment of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
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3
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Helbing J, Farley B, Gu A, Zhao AY, Siram G, Stein B, Chodos MD. Diabetes Mellitus and Total Ankle Arthroplasty Complications. Foot Ankle Int 2024; 45:320-327. [PMID: 38327200 DOI: 10.1177/10711007241226929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Postoperative infection, aseptic loosening, and perioperative medical complications after total ankle arthroplasty (TAA) are all devastating problems. While previous studies have shown diabetes as a risk factor predisposing patients to postoperative complications, not all literature supports this association following TAA. The goal of this study is to determine if diabetes influences midterm outcomes following TAA. METHODS An insurance database was utilized to identify patients undergoing TAA for ankle arthritis with a concurrent diagnosis of diabetes based on Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10), diagnosis and procedure codes from 2010 to 2021. The postoperative outcomes of all-cause revision, periprosthetic joint infection (PJI), septic revision, and aseptic revision were compared between patients with and without diabetes with a minimum 2-year follow-up using Kaplan-Meier and multivariate Cox proportional hazards analyses. Patient demographics, comorbidities, and Charlson Comorbidity Index were analyzed via univariate and multivariate analysis. RESULTS The study population included 8317 patients, 345 (4.1%) of whom had a concurrent diabetes diagnosis, who underwent TAA. After multivariate Cox proportional hazards analysis, the 5-year cumulative incidence of being coded as having PJI was 7.3% in patients with known diabetes compared to 3.9% in patients without known diabetes, with a 95% increased risk (hazard ratio [HR] 1.95, 95% CI 1.15-3.30, P = .01). Patients with diabetes also demonstrated a 5-year cumulative incidence of septic revision of 1.4% compared to 0.4% in those without, with a 363% increased risk (HR 4.63, 95% CI 1.22-17.52, P = .02). However, there was no difference in the 5-year cumulative incidence of all-cause revision TAA with 4.6% in patients with diabetes and 4.3% in those without (HR 1.29, 95% CI 0.69-2.44, P = .42). CONCLUSION In this database, the 5-year risk of PJI and septic revision was higher among patients with diabetes compared to those without, but cumulative incidence of all-cause revision TAA was not different between groups. LEVEL OF EVIDENCE Level III, retrospective cohort database study.
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Affiliation(s)
- Jordan Helbing
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Benjamin Farley
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Alex Gu
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Amy Y Zhao
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Gautam Siram
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
- Centers for Advanced Orthopedics Summit Orthopedic Surgery, Bethesda, MD, USA
| | - Benjamin Stein
- Centers for Advanced Orthopaedics, LLC, Washington, DC, USA
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Marc D Chodos
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
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Rucinski K, Cook JL, Schweser KM, Crist BD. Short-Term Outcomes After Bipolar Osteochondral Allograft Transplantation (OCAT) in the Ankle. J Foot Ankle Surg 2024; 63:207-213. [PMID: 37972816 DOI: 10.1053/j.jfas.2023.11.002] [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: 06/14/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
Treatment options for symptomatic cartilage loss in the ankle are not consistently effective. This study documents initial outcomes for patients undergoing bipolar OCAT in the ankle after advances in tissue preservation, transplantation techniques, and patient management strategies were implemented. Patients were prospectively enrolled into a registry designed to follow outcomes after OCAT in the ankle. Fourteen patients were included for analyses (12 primary OCAT, 2 revision OCAT). Four patients underwent Bipolar OCAT (tibia, talus) and 10 Bipolar+ OCAT (tibia, talus, fibula). Short-term (median follow-up 43, range 13-73 months) success was documented for 13 patients. Radiographic assessments indicated OCA integration and maintenance of joint space in 12 patients. Statistically significant (p < .030) and clinically meaningful improvements in AAOS and VAS pain scores were noted at 3 months, 6 months, 1 year, and 2 years following OCA transplantation when compared to preoperative measures. For patients that were nonadherent to postoperative restriction and rehabilitation protocols, all 1-year postoperative PROs were significantly lower (p < .050) than for patients who were adherent. The successful outcomes documented in 13 of 14 patients in conjunction with significant and clinically meaningful improvements in patient-reported measures of pain and function support OCA transplantation as an appropriate treatment option in indicated patients. These improvements in outcomes were associated with advances in OCA preservation, preimplantation treatment, transplantation techniques, and patient management strategies, suggesting this shift in practice be considered for OCA transplantation in the ankle.
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Affiliation(s)
- Kylee Rucinski
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO; Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO
| | - James L Cook
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO; Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO
| | - Kyle M Schweser
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO
| | - Brett D Crist
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO; Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO.
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5
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Varga C, Váncsa S, Agócs G, Hegyi P, Gidró BT, Szőke G, Domos G, Rodler E, Kocsis G, Holnapy G. Obesity and Ankle Prosthesis Revision: A Systematic Review and Meta-analysis. Foot Ankle Int 2023; 44:1305-1318. [PMID: 37902184 DOI: 10.1177/10711007231201158] [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: 10/31/2023]
Abstract
BACKGROUND The increasing number of total ankle arthroplasties (TAAs) has led to growing evidence on the risk factors for complications after surgery. However, the role of obesity in this patient group has been the subject of much debate. Therefore, this systematic review aimed to investigate the evidence for untoward effects of obesity following TAA. METHODS We conducted a comprehensive search on April 28, 2023, in MEDLINE (via PubMed), Embase, and CENTRAL. Eligible observational studies reported on the short- and long-term outcomes of primary TAA, comparing patients with and without obesity (defined as body mass index > 30). Using a random effects model, we calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) from 2 by 2 tables (event and nonevent in the obese and nonobese primary TAA groups). RESULTS Nine studies with 10 388 patients were eligible for inclusion in the meta-analysis. We found significantly higher odds of revision in the obese group compared to the nonobese group (OR = 1.68, CI: 1.44-1.95). However, the odds of overall perioperative complications (OR = 1.55, CI: 0.50-4.80) and wound complications (OR = 1.34, CI: 0.29-6.20) were nonsignificantly higher in the obese group. CONCLUSION Based on our results, obesity may have affected long-term outcomes following TAA and may have negatively affected the prosthesis's survival.
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Affiliation(s)
- Csaba Varga
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Gergely Agócs
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | | | - György Szőke
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Gyula Domos
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Endre Rodler
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - György Kocsis
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Gergely Holnapy
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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Bowcutt JT, Shibuya N, Jupiter DC. Preoperative Serum Albumin and Other Risk Factors Related to 30-Day Postoperative Complications in Total Ankle Arthroplasty. J Foot Ankle Surg 2023; 62:981-985. [PMID: 37549784 DOI: 10.1053/j.jfas.2023.07.008] [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: 04/06/2023] [Revised: 06/08/2023] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
This study investigates effects of preoperative albumin on 30-day total ankle arthroplasty (TAA) outcomes. Additionally, other preoperative risk factors are addressed, including American Anesthesia Society (ASA) class, functional status, chronic obstructive pulmonary disease (COPD), diabetes, smoking status, time of operation, and age. Outcomes assessed were readmission, return to operating room, surgical site infection, wound dehiscence, and total length of stay (TLOS). Data were extracted from the National Surgical Quality Improvement Program database. Bivariate comparisons were analyzed using correlation coefficients, t tests, or chi-squared tests; multivariate comparisons used linear or logistic regression. Our data showed no significant correlation between serum albumin and patients with readmission (odds ratio -0.14, P = 0.06), return to operating room (-0.07, P = 0.61), or surgical site infection (-0.08, P = 0.56). With bivariate analysis, functional status and COPD were significant for readmission (12.67, P < 0.001 and 7.83, P < 0.001, respectively) and dehiscence (30.52, P < 0.001 and 6.74, P = 0.05, respectively), while high ASA class (0.4, P = 0.01), increased age (0.1, P < 0.001), and longer time of operation (0.19, P < 0.001) were associated with longer TLOS. With multivariate analysis, functional status showed higher odds of readmission (7.42, P = 0.02) and dehiscence (20.47, P = 0.01), while COPD showed higher odds for readmission (6.65, P < 0.001) and longer TLOS (0.31, P = 0.05). High ASA class (0.42, P < 0.001) and female sex (0.32, P < 0.001) also had higher odds for longer TLOS. In summary, low albumin was not significant for readmission, return to operating room, or surgical site infection in TAA. COPD, functional status, high ASA class, longer time of operation, increased age, and female sex were all correlated with adverse outcomes in TAA.
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Affiliation(s)
- Jeffrey T Bowcutt
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX
| | - Naohiro Shibuya
- The University of Texas Rio Grande Valley, School of Podiatric Medicine, Edinburg, TX
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX; Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX.
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7
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Fritz J, Rashidi A, de Cesar Netto C. Magnetic Resonance Imaging of Total Ankle Arthroplasty: State-of-The-Art Assessment of Implant-Related Pain and Dysfunction. Foot Ankle Clin 2023; 28:463-492. [PMID: 37536814 DOI: 10.1016/j.fcl.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Total ankle arthroplasty (TAA) is an effective alternative for treating patients with end-stage ankle degeneration, improving mobility, and providing pain relief. Implant survivorship is constantly improving; however, complications occur. Many causes of pain and dysfunction after total ankle arthroplasty can be diagnosed accurately with clinical examination, laboratory, radiography, and computer tomography. However, when there are no or inconclusive imaging findings, magnetic resonance imaging (MRI) is highly accurate in identifying and characterizing bone resorption, osteolysis, infection, osseous stress reactions, nondisplaced fractures, polyethylene damage, nerve injuries and neuropathies, as well as tendon and ligament tears. Multiple vendors offer effective, clinically available MRI techniques for metal artifact reduction MRI of total ankle arthroplasty. This article reviews the MRI appearances of common TAA implant systems, clinically available techniques and protocols for metal artifact reduction MRI of TAA implants, and the MRI appearances of a broad spectrum of TAA-related complications.
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Affiliation(s)
- Jan Fritz
- Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, Duke University, Durham, NC, USA.
| | - Ali Rashidi
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, 3rd Floor, Rm 313, New York, NY 10016, USA
| | - Cesar de Cesar Netto
- Department of Radiology, Molecular Imaging Program at StanDepartment of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
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Ratnasamy PP, Maloy GC, Oghenesume OP, Peden SC, Grauer JN, Oh I. The Burden of Revision Total Ankle Replacement Has Increased From 2010 to 2020. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231198234. [PMID: 37767009 PMCID: PMC10521287 DOI: 10.1177/24730114231198234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Background Total ankle replacement (TAR) surgery has increased in recent decades. The aim of this study was to investigate the evolving burden of revision surgery and risk factors and timing of revision or explant. Methods Using the 2010 to 2020 PearlDiver M151Ortho data set, this retrospective cohort study identified primary TAR, TAR revision, and TAR explant patients via Current Procedural Terminology (CPT) and International Classification of Disease Procedural (ICD-P) codes. This database contains billing claims information across all payers and sites of care in the United States. Patient factors investigated included age, sex, and Elixhauser Comorbidity Index (ECI). Annual incidence for primary TAR was normalized per 100 000 covered lives in the data set for each year of study and recorded. Annual incidence of revision TAR and explant were normalized per 100 TARs performed for each year of study. Multivariate logistic regression analyses were performed to determine independent risk factors for revision TAR or explant. For explants, the eventual intervention by 2 years was analyzed. Ten-year timing and survival to revision or explant surgery following unilateral TAR were characterized. Results A total of 10 531 primary, 1218 revision, and 1735 explant TARs were identified. After normalization, TAR utilization increased by 284% from 2010 to 2020, annual TAR revisions rose 28%, and annual TAR explants decreased 65%. Independent predictors of revision TAR were younger age (odds ratio [OR] 1.29 per decade decrease) and higher ECI (OR 1.23 per 2-point increase). Independent predictors of explant included younger age (OR 1.80 per decade decrease), female sex (OR 1.17), and higher ECI (OR 1.35 per 2-point increase). The 10-year implant survival rate was 91.8%, of which 73% of revisions and 83% of explants occurred in the first 3 years following index TAR. Conclusion TAR utilization has grown substantially over the past decade, with minimal increases in the annual rate of revision surgery with respect to index procedures performed. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Philip P. Ratnasamy
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Gwyneth C. Maloy
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | | | - Sean C. Peden
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N. Grauer
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Irvin Oh
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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9
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Gupta P, Quan T, Abdo MG, Manzi JE, Knapp B, Shaffer G. Thirty-Day Morbidity and Mortality in Patients With COPD Following Open Reduction and Internal Fixation for Rotational Ankle Fractures. J Foot Ankle Surg 2022; 61:1275-1279. [PMID: 35501248 DOI: 10.1053/j.jfas.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/02/2022] [Accepted: 03/29/2022] [Indexed: 02/03/2023]
Abstract
Prior orthopedic literature has found patients with chronic obstructive pulmonary disease (COPD) to be at an increased risk for postoperative morbidity and mortality. Thus, the purpose of this study is to identify whether there are any differences in risk for 30-day morbidity or mortality following ORIF for ankle fractures between adult patients with COPD and without COPD. Patients undergoing operative treatment for ankle fracture were identified in the National Surgical Quality Improvement Program database from 2006 to 2018. Patients were divided into 2 cohorts: non-COPD and COPD patients. In this analysis, demographics data, medical comorbidities, and thirty-day postoperative outcomes were analyzed between the 2 cohorts. Bivariate and multivariate analyses were performed. Of 10,346 total patients who underwent operative treatment for ankle fracture, 9986 patients (96.5%) did not have a history of COPD whereas 360 (3.5%) had COPD. Following adjustment to control for demographic and comorbidity data, relative to patients without COPD, those with COPD had an increased risk of pneumonia (odds ratio [OR] 4.601; p = .001), unplanned intubation (OR 3.085; p = .043), and hospital readmission (OR 1.828; p = .020). Patients with COPD did not have a statistically significant difference with regards to mortality (OR 2.729; p = .080). Adult patients with COPD are at an increased risk for pneumonia, unplanned intubation, and hospital readmission within 30 days following ORIF of ankle fractures compared to patients without COPD. Despite these risks, this is a relatively safe procedure for these patients and the presence of COPD alone should not serve as a barrier to surgery.
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Affiliation(s)
- Puneet Gupta
- Department of Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Theodore Quan
- Department of Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Magid G Abdo
- Burrell College of Osteopathic Medicine, Las Cruces, NM
| | | | - Brock Knapp
- Department of Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Gene Shaffer
- Department of Orthopedic Surgery, Einstein Healthcare Network, Philadelphia, PA
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Benthien RA. Failed Total Ankle Arthroplasty and Our Expanding Shoreline of Peril: Commentary on an article by Bakur A. Jamjoom, BMBS, MCh, FRCS, et al.: "Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using the INBONE II Prosthesis". J Bone Joint Surg Am 2022; 104:e78. [PMID: 36069802 DOI: 10.2106/jbjs.22.00764] [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: 02/01/2023]
Affiliation(s)
- Ross A Benthien
- Orthopedic Associates of Hartford, The Bone and Joint Institute, Hartford Hospital, Hartford, Connecticut
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11
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Tarricone A, Gee A, Chen S, De La Mata K, Muser J, Axman W, Krishnan P, Perake V. A Systematic Review and Meta-analysis of Total Ankle Arthroplasty or Ankle Arthrodesis for Treatment of Osteoarthritis in Patients With Diabetes. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221112955. [PMID: 35924005 PMCID: PMC9340373 DOI: 10.1177/24730114221112955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: End-stage ankle osteoarthritis often requires one of 2 major surgical procedures: total ankle arthroplasty or ankle arthrodesis. Although the gold standard has been arthrodesis, patients with diabetes represent a unique cohort that requires additional considerations because of their decreased mobility and risk factors for cardiovascular complications. The purpose of this study is to review odds of major and minor adverse events for patients with diabetes and patients without diabetes in both total ankle arthroplasty and ankle arthrodesis. Methods: A total of 14 articles published between 2010 and 2020 were included in this review. Databases included PubMed, Scopus, MEDLINE/Embase, and Cochrane Library. Key words included ankle arthroplasty, total ankle arthroplasty, ankle arthrodesis, and diabetes. Results: The total number of procedures was 26 287, comprising 13 830 arthroplasty and 12 457 arthrodesis procedures. There was a significant association between patients with diabetes treated with arthrodesis and major adverse events (odds ratio [OR] 1.880, 95% CI 1.279, 2.762), whereas no significant association was observed between patients with diabetes treated with arthroplasty and major adverse events (OR 1.106, 95% CI 0.871, 1.404). Conclusion: This meta-analysis suggests patients with diabetes to be at significantly higher risk for major and minor adverse events after undergoing ankle arthrodesis. However, it suggests no significant differences in major adverse events between patients with diabetes and patients without diabetes having undergone total ankle arthroplasty. Level of Evidence: Level III, systematic review and meta-analysis.
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Affiliation(s)
- Arthur Tarricone
- SUNY Downstate Medical Center University Hospital of Brooklyn, Brooklyn, NY, USA
| | - Allen Gee
- Nova Southeastern University, Dr Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL, USA
| | - Simon Chen
- Faculty Of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Karla De La Mata
- Lenox Hill Hospital at Northwell Health New York, New York, NY, USA
| | - Justin Muser
- Our Lady of Lourdes Memorial Hospital, Binghamton, NY, USA
| | - Wayne Axman
- NYC Health, Hospitals/Queens Hospital Center, Jamaica, NY, USA
| | | | - Vinayak Perake
- NYC Health, Hospitals/Queens Hospital Center, Jamaica, NY, USA
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12
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Del Balso C, Halai MM, MacLeod MD, Sanders DW, Rahman Lawendy A. Factors Predictive of Early Complications Following Total Ankle Arthroplasty. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221102456. [PMID: 35722173 PMCID: PMC9201329 DOI: 10.1177/24730114221102456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The safety of outpatient total ankle arthroplasty (TAA), and factors
predictive of early complications are poorly understood. The objective of
this study was to determine the frequency of early complications in patients
undergoing outpatient TAA compared to a matched inpatient TAA cohort.
Factors predictive of early complications following TAA are elucidated. Methods: A retrospective review of prospectively collected data from the 2011-2018
American College of Surgeons–National Surgical Quality Improvement Program
(ACS-NSQIP) database was performed. An unadjusted analysis comparing
complication rates in outpatient, and inpatient TAA was performed followed
by a propensity score–matched cohort analysis. A multivariate logistic
regression model was then used to identify significant independent
predictors for complications, reoperation, and readmission following
TAA. Results: A total of 1487 patients (198 outpatient, 1289 inpatient) undergoing TAA were
included in the study. Inpatient TAA was associated with increased 30-day
readmission compared with outpatient TAA (3.54% vs 0.51%, P
= .032) in a matched cohort analysis. Thirty-eight (2.6%) patients had a
minor complication, with 16 (1.1%) patients having a major complication
after TAR. Nineteen (1.3%) patients underwent reoperation, and 42 (2.8%)
patients were readmitted within 30 days of the index TAR. Multivariate
analysis identified factors predictive of early complications to include
length of stay (LOS) >2 days, smoking, hypertension, bleeding disorders,
and diabetes mellitus. Conclusion: From this relatively limited data set, outpatient TAA appears to be safe for
management of end-stage ankle arthritis in select patients. Inpatient status
was associated with an increased rate of 30-day readmission following TAA.
Postoperative length of stay >2 days, smoking, hypertension, bleeding
disorders, and diabetes mellitus were identified to be associated with early
postoperative complications following TAA in this cohort. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Christopher Del Balso
- Department of Surgery, Division of
Orthopaedic Surgery, London Health Sciences Centre–Victoria Hospital, Western
University, London, Ontario, Canada
- Christopher Del Balso, MBBS, MSc,
Department of Surgery, Division of Orthopaedic Surgery, London Health Sciences
Centre – Victoria Hospital, Western University, 800 Commissioners Rd E, London,
ON N6A 5W9, Canada.
| | - Mansur M. Halai
- Department of Surgery, Division of
Orthopaedic Surgery, St. Michael’s Hospital, University of Toronto, Toronto,
Ontario, Canada
| | - Mark D. MacLeod
- Department of Surgery, Division of
Orthopaedic Surgery, London Health Sciences Centre–Victoria Hospital, Western
University, London, Ontario, Canada
| | - David W. Sanders
- Department of Surgery, Division of
Orthopaedic Surgery, London Health Sciences Centre–Victoria Hospital, Western
University, London, Ontario, Canada
| | - Abdel Rahman Lawendy
- Department of Surgery, Division of
Orthopaedic Surgery, London Health Sciences Centre–Victoria Hospital, Western
University, London, Ontario, Canada
| |
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