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Staged vs concurrent hardware removal in total ankle arthroplasty.

Antonio Mazzotti1,2, Alberto Arceri3, Simone O Zielli1

  • 11st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, Italy.

Archives of Orthopaedic and Trauma Surgery
|November 23, 2023
PubMed
Summary

For total ankle arthroplasty (TAA) with hardware removal, a staged approach may offer benefits over concurrent removal, particularly for complex cases requiring major incisions, leading to fewer complications and faster recovery.

Keywords:
ConcurrentHardware removalStagedTimingTotal ankle arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Arthroplasty
  • Trauma Reconstruction

Background:

  • Posttraumatic ankle osteoarthritis frequently necessitates hardware removal prior to total ankle arthroplasty (TAA).
  • Managing internal fixation removal is a common consideration in TAA procedures.

Purpose of the Study:

  • To compare the outcomes of staged versus concurrent hardware removal during TAA.
  • To evaluate neurovascular complications, wound healing, recovery time, aesthetics, and surgical duration.

Main Methods:

  • Retrospective review of 57 patients undergoing TAA with prior internal fixation.
  • Patients were divided into staged (Group A) and concurrent (Group B) hardware removal groups.
  • Subgroup analysis based on surgical approach (single, minor additional, major additional).

Main Results:

  • No significant overall difference between staged and concurrent removal, except for longer surgical time in the concurrent group.
  • In major additional incision subgroups, concurrent removal showed higher wound complications and revision rates.
  • Staged removal in the major additional incision subgroup resulted in a shorter time to full weight bearing.

Conclusions:

  • Overall, no definitive superiority of staged over concurrent hardware removal in TAA was found.
  • For patients requiring a major additional incision, staged removal demonstrated advantages: reduced surgical time, fewer wound complications, and quicker weight-bearing recovery.