Single stage revision ankle arthroplasty, Is it safe?

Area of Science:

• Orthopedic Surgery
• Arthroplasty Research
• Revision Arthroplasty

Background:

• Total ankle replacement (TAR) procedures are increasing, leading to a rise in revision total ankle replacement (rTAR).
• When TAR fails, revision surgery or arthrodesis are options, with revision arthroplasty being preferred in some centers.
• Uncertainty exists regarding the optimal approach for rTAR: single-stage versus two-stage procedures.

Purpose of the Study:

• To compare the outcomes of single-stage versus two-stage revision ankle arthroplasty.
• To determine if a single-staged approach increases complications or impairs patient outcomes compared to a two-stage approach.

Main Methods:

• A retrospective cohort study analyzed prospectively collected data of rTAR procedures performed between November 2016 and January 2023.
• Data reviewed included preoperative and intraoperative microbiology, infection rates, tourniquet time, hospital stay, wound complications, and patient-reported outcome measures (PROMs).
• Patients undergoing single-staged rTAR were compared to those undergoing two-staged rTAR.

Main Results:

• Eighty-six rTAR patients (mean age 71.4 years) were included, with 74 single-staged and 14 two-staged procedures.
• No significant difference in infection rates, wound complications, or PROMs was observed between the single-staged and two-staged groups.
• Single-staged procedures had significantly different tourniquet times but no increased complication rate.

Conclusions:

• Single-staged revision ankle arthroplasty is a safe and effective alternative to two-stage procedures for patients with a low index of suspicion for infection.
• The study represents the largest series to date comparing these approaches.
• No significant difference in complications or outcomes was found between single-staged and two-stage revision ankle replacement.