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Complications and failure after total ankle arthroplasty
Adrienne A Spirt1, Mathieu Assal, Sigvard T Hansen
1Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington 98105, USA. aaspirt@hotmail.com
Summary
Reoperation is common after total ankle arthroplasty, especially in younger patients. While most prostheses can be salvaged, outcomes remain uncertain.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Reconstructive Surgery
Background:
- Second-generation total ankle arthroplasty (TAA) shows promising intermediate-term results.
- Understanding reoperation and failure rates is crucial for TAA patient management.
- Identifying predictors of TAA revision surgery can optimize patient selection and outcomes.
Purpose of the Study:
- To determine the frequency and causes of reoperation and failure after TAA.
- To identify demographic and clinical predictors associated with TAA revision.
- To evaluate the prosthetic survival rate following TAA.
Main Methods:
- Retrospective review of 306 primary total ankle arthroplasties using the DePuy Agility system (1995-2001).
- Analysis of patient demographics, indications, adjuvant procedures, and reoperation details.
- Kaplan-Meier and Cox regression analyses to assess survival and predictors of reoperation/failure.
Main Results:
- 28% of patients (85) required 127 reoperations; common causes included heterotopic bone removal and axial malalignment correction.
- Younger age was the sole significant predictor of reoperation and failure.
- Five-year prosthetic survival with reoperation as endpoint was 54%; survival without failure was 80% (89% for patients >54 years).
Conclusions:
- Second-generation TAA devices exhibit a relatively high reoperation rate.
- Younger patient age negatively impacts TAA reoperation and failure rates.
- While most prostheses are salvageable, long-term functional outcomes require further investigation.