Risk Factors for Failure of Total Ankle Replacements: A Data Linkage Study Using the National Joint Registry and NHS...

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Epidemiology

Background:

• Ankle replacement is increasingly common, yet patient selection and risk factors for failure require further investigation.
• Limited studies exist on predicting total ankle replacement (TAR) outcomes.
• Identifying failure predictors is crucial for optimizing patient selection and surgical success.

Purpose of the Study:

• To identify and analyze risk factors associated with total ankle replacement failure.
• To improve patient selection criteria for ankle arthroplasty.
• To enhance long-term outcomes for patients undergoing ankle replacement surgery.

Main Methods:

• A data linkage study combining the National Joint Registry (NJR) and NHS Digital data.
• Failure defined as removal or exchange of implanted components.
• Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression models were employed.

Main Results:

• Overall 5-year survival rate for total ankle replacements was 90.2%.
• Increased risk of failure was associated with younger age (HR 0.96) and higher body mass index (BMI; HR 1.03).
• Underlying etiology also influenced failure risk (HR 0.88), with rheumatoid arthritis patients demonstrating higher survivorship than osteoarthritis patients.

Conclusions:

• Younger age and higher BMI are significant risk factors for primary ankle replacement failure.
• Rheumatoid arthritis is associated with better survivorship after ankle replacement compared to osteoarthritis.
• These findings can inform clinical decision-making and patient counseling regarding ankle arthroplasty.