Outcomes of Total Ankle Arthroplasty in Postfracture Ankle Arthritis
Journal
Foot & Ankle International
ISSN
1071-1007
1944-7876
Date Issued
2023
Author(s)
Jaeyoung Kim
Ruben Radkievich
Rami Mizher
Isabel Shaffrey
Martin O’Malley
Jonathan Deland
Constantine Demetracopoulos
Scott Ellis
Type
Resource Types::text::journal::journal article
Abstract
<jats:sec><jats:title>Background:</jats:title><jats:p> Ankle arthritis that develops after fracture accounts for a significant portion of ankle arthritis necessitating total ankle arthroplasty (TAA). It remains unknown whether TAA in postfracture patients produces equivalent outcomes to those without fracture history. The purpose of this study was to evaluate the medium-term outcomes of TAA in postfracture ankle arthritis compared to those without fracture history. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> This study reviewed 178 ankles from 171 consecutive patients who underwent TAA in our institution between 2007 and 2017 and completed a minimum 5-year follow-up. Four different TAA systems were utilized by 6 surgeons. Based on fracture history, patients were divided into 2 groups: the postfracture group (n = 63; median age 65.7 years; median follow-up 5.9 years) and the nonfracture group (n = 115; median age 64.4 years; median follow-up 6.2 years). Types and rates of complications including revision and reoperation were compared. Minimum 5-year Foot and Ankle Outcome Score (FAOS) and postoperative improvement were investigated. A subgroup analysis was performed to determine whether outcomes differ between intraarticular fracture patients (n = 43) and extraarticular fracture patients (n = 20). </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Both groups exhibited comparable postoperative improvement and final FAOS scores. The postfracture group had a significantly higher reoperation rate than the nonfracture group (20 of 63, 31.7%, vs 17 of 115, 14.8%; P = .011), with gutter impingement being the most common cause. There were 3 revisions in each group. In the subgroup analysis, we found no evidence of statistical difference between the intraarticular fracture group and the extraarticular fracture group in terms of FAOS scores, revision, and reoperation rates. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> In this single-center, retrospective comparative study, we found total ankle arthroplasty in patients with a history of fractures around the ankle joint had no evidence of statistical difference in patient-reported outcomes and implant survivorship but led to a higher rate of nonrevision reoperation following surgery. In the much smaller subset of patients with previous fracture, we did not find that those with a history of intraarticular fracture had inferior outcomes after TAA when compared to those with a history of extraarticular fracture. </jats:p></jats:sec><jats:sec><jats:title>Level of Evidence:</jats:title><jats:p> Level III, case-control study. </jats:p></jats:sec>
Subjects
ankle arthritis
;
arthroplasty
;
articular
;
complication
;
fracture
;
posttraumatic
;
reoperation
;
total ankle
;
aged
;
ankle
;
ankle joint
;
arthritis
;
arthroplasty, replacement, ankle
;
case-control studies
;
fractures, bone
;
humans
;
intra-articular fractures
;
middle aged
;
reoperation
;
retrospective studies
;
treatment outcome
;
nonsteroid antiinflammatory agent
;
polyethylene
;
achilles tendinitis
;
adhesiolysis
;
adult
;
aged
;
american orthopedic foot and ankle society score
;
ankle arthritis
;
ankle arthrodesis
;
ankle arthroplasty
;
ankle fracture
;
article
;
calcaneal osteotomy
;
case control study
;
cohort analysis
;
comparative study
;
computer assisted tomography
;
controlled study
;
daily life activity
;
debridement
;
demographics
;
device failure
;
extensor hallucis longus muscle
;
female
;
follow up
;
fracture fixation
;
fracture nonunion
;
gastrocnemius muscle
;
geometry
;
human
;
intraarticular fracture
;
likert scale
;
limb deformity
;
male
;
malleolus fracture
;
medical device malfunction
;
metatarsal osteotomy
;
outcomes research
;
overall survival
;
patient-reported outcome
;
postoperative care
;
posttraumatic arthropathy
;
preoperative care
;
radiography
;
range of motion
;
reoperation
;
retrospective study
;
revision arthroplasty
;
self report
;
stress fracture
;
subtalar joint
;
survivorship
;
talonavicular joint
;
tarsal canal syndrome
;
tarsometatarsal joint
;
tibia fracture
;
tibiofibular joint
;
tibiotalar angle
;
valgus knee
;
varus knee
;
wound infection
;
ankle
;
ankle replacement
;
arthritis
;
fracture
;
intraarticular fracture
;
middle aged
;
treatment outcome