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Bernasconi A, Izzo A, Sgadari A, D'Agostino M, Mariconda M, Goldberg AJ. Median age of patients undergoing total ankle replacement has not significantly changed between 1999 and 2023: A systematic review of prospective studies. Foot Ankle Surg 2024:S1268-7731(24)00156-5. [PMID: 39069398 DOI: 10.1016/j.fas.2024.07.007] [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: 03/27/2024] [Revised: 06/22/2024] [Accepted: 07/13/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Total ankle replacement (TAR) is an effective treatment for end-stage osteoarthritis. The aim of this systematic review was to assess the age of patients undergoing TAR in prospective comparative studies. Our hypothesis is that the age reported in most recent papers might be lower than those reported in older papers. METHODS This systematic review was performed using Pubmed, Scopus, EMBASE and Cochrane databases. Only Level I and II studies dealing with TAR were included. Data regarding demographics, study design, number of cohorts in each study, year of publication and year/years in which surgery was performed were extracted. A two-fold analysis was conducted building groups of patients based on the year of publication and creating 1) two groups (before and after the median year) and 2) three groups (using tertiles) in order to compare age of patients operated in different period of times. A comparison was also performed considering the median year of surgery for patients undergoing TAR. RESULTS Overall 59 cohorts (42 studies, published between 1999 and 2023; median year of publication: 2017) were included (6397 ankles, 6317 patients, median age 63 years). The difference between the median age for 27 cohorts published until 2016 (weighted median 63 years; IQR, 62.5-64) and the median age for 32 cohorts published after 2017 (weighted median 63.2 years; IQR, 63-67.8) was not statistically significant (p = 0.09). The division in tertiles did not reveal any significant change in the weighted median age at surgery (T1 (1999-2014; 63.2 years; IQR, 62.8-64.1), T2 (2015-2018; 63 years; IQR,63-63.5) and T3 (2019-2023; 63.2 years; IQR, 62.6-67.8)) over time (p = 0.65). The median age of patients operated between 1999 and 2008 vs 2009 and 2023 (data from 48 cohorts) was not different either (p = 0.12). CONCLUSION According to this review of prospective studies published between 1999 and 2023, the median age for patients undergoing TAR over the last two decades has been 63 years, remaining steady with no significant changes over time. LEVEL OF EVIDENCE Level II - systematic review including Level I and Level II studies.
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Affiliation(s)
- Alessio Bernasconi
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.
| | - Antonio Izzo
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.
| | - Arianna Sgadari
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.
| | - Martina D'Agostino
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.
| | - Massimo Mariconda
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.
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Wu KA, Anastasio AT, Lee D, Kim BI, Valan B, Krez AN, Adams SB, Nunley JA, Easley ME, DeOrio JK. Revision Total Ankle Arthroplasty Using the INBONE II System. Foot Ankle Int 2024; 45:557-566. [PMID: 38445584 DOI: 10.1177/10711007241232633] [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: 03/07/2024]
Abstract
BACKGROUND The utilization of total ankle arthroplasty (TAA) for managing severe ankle osteoarthritis has become increasingly common, leading to a higher occurrence of revision TAA procedures because of failure of primary TAA. This study aims to examine the clinical results associated with revision TAA using the INBONE II system. Given the growing number of TAA revision procedures and a focus on motion-preserving salvage options, we evaluated our early experience with revision TAA. METHODS A retrospective analysis was conducted on a group of 60 presumed noninfected patients who underwent revision TAA with the INBONE II system. Detailed information was collected on patient demographics, implant characteristics, concurrent procedures, and complications. The implant survival was estimated using Kaplan-Meier analysis. RESULTS The study revealed high complication rates but generally fair clinical outcomes for revision TAA using the INBONE II system. Complications were observed in 22 patients (36.7%), including persistent pain (n = 6), nerve injury/impingement (n = 5), infection (n = 3), fracture (n = 3), implant failure (n = 3), impaired wound healing (n = 2), and osteolysis (n = 3). The 3-year survivorship rate from reoperation was 92.0% (82.7%-100.0%) whereas the 3-year survivorship rate from major complications was 90.4% (80.8%-100.0%). CONCLUSION We report high complication rates but generally fair clinical results for revision TAA utilizing the INBONE II system.
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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, USA
| | - Albert T Anastasio
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Dongoh Lee
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Republic of Korea
| | - Billy I Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Bruno Valan
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Alexandra N Krez
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Samuel B Adams
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - James A Nunley
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Mark E Easley
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - James K DeOrio
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
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Henry JK, Teehan E, Deland J, Ellis S, Demetracopoulos C. Lessons From Revision Total Ankle Replacement: Tibias Fail Earlier, and Taluses Fail Later (and Fail Again). Foot Ankle Int 2024:10711007241255112. [PMID: 38798096 DOI: 10.1177/10711007241255112] [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: 05/29/2024]
Abstract
BACKGROUND The literature on survivorship and outcomes after revision total ankle replacement (TAR) in the modern era is limited. This study aimed to describe the timing to revision and survivorship after revision TAR. We hypothesized that tibial-sided failures would occur earlier after the primary TAR, and secondary revisions after failure of revision TAR would occur more due to talar-sided failures than tibial-sided failures. METHODS This is a single-institution retrospective study of TAR patients with minimum 2-year follow-up. Revision TARs (defined as exchange of tibial and/or talar components) for aseptic causes with any implant were included. Etiology of failure necessitating revision and ultimate outcomes after revision (survival of TAR revision, additional revision, conversion to fusion, and below-knee amputation [BKA]) were recorded. RESULTS There were 46 revision TARs, with mean age of 60.6 (range: 31-77) years and mean 3.5 years' follow-up postrevision. Revisions for tibial failure occurred significantly earlier (n = 22, 1.3 ± 0.5 years after index procedure) than those for talar failure (n = 19, 2.3 ± 1.7 years after index procedure) or combined tibial-talar failure (n = 5, 3.4 ± 3.4 years after index procedure) (P = .015). Revisions for tibial-only failure had better survival (95.5%) than revisions for talar or combined tibial-talar failures: 26% of talar failures and 20% of combined tibial-talar failures underwent ≥1 revisions. Of the 6 additional revisions after failure of the talar component, 1 ultimately underwent BKA, 2 were converted to total talus replacement, 2 were revised to modular augmented talar components, and 1 was treated with explant and cement spacer for PJI after the revision. CONCLUSION TAR tibial failures occurred earlier than talar failures or combined tibial-talar failures. Revisions for talar failures and combined tibial-talar failures were more likely to require additional revision or ultimately fail revision treatment. This is important given the consequences of talar implant subsidence, bone necrosis, loss of bone stock, and limited salvage options. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Jensen K Henry
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Emily Teehan
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan Deland
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Scott Ellis
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
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Huh J, Louis-Ugbo J, Hembree WC, Wagner E, Chodos MD, Zingas CN, Vopat BG, Dalal A, Alhadhoud M, Sherman TI. 2023 Evidence-Based Medicine (EBM) Update. Foot Ankle Int 2024; 45:547-554. [PMID: 38676415 DOI: 10.1177/10711007241242133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Affiliation(s)
- Jeannie Huh
- Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | | | - Walter C Hembree
- MedStar Orthopaedic Institute, Georgetown University School of Medicine, Baltimore, MD, USA
| | - Emilio Wagner
- Traumatologo Subespecialista en Cirugia de Tobillo y Pie, Santiago, Chile
| | | | | | - Bryan G Vopat
- University of Kansas Health System, Kansas City, KS, USA
| | - Aliasgar Dalal
- St. Louis University Care Physician Group, St. Louis, MO, USA
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Rodriguez-Merchan EC. Ankle arthrodesis and total ankle replacement in patients with congenital bleeding disorders suffering from severe ankle arthropathy. Expert Rev Hematol 2024; 17:1-8. [PMID: 38131332 DOI: 10.1080/17474086.2023.2299301] [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] [Received: 10/05/2023] [Accepted: 12/21/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION In patients with congenital bleeding disorders suffering from severe ankle arthropathy, when conservative treatment and joint-preserving surgical techniques fail, there are two possible non-joint-preserving options: ankle arthrodesis (AA) and total ankle replacement (TAR). AREAS COVERED The scope and aim of this article was to analyze the current role of AA and TAR in patients with congenital bleeding disorders suffering from severe ankle arthropathy. EXPERT OPINION In patients with congenital bleeding disorders, both TAR and AA provide good results, mainly in terms of pain relief, although they are not exempt from complications (between 0% and 33% in TAR and between 5% and 23.5% in AA). The current controversy about which of the two surgical techniques, TAR or AA, gives better results, the current literature is not able to resolve it in patients with congenital bleeding disorders. While this question is being answered, my opinion regarding patients with congenital bleeding disorders is that the age of the patient must be taken into account. Given known prosthetic survival rates, the older the patient, the more we might be inclined to indicate TAR. Conversely, AA may be more appropriate for relatively young patients.
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