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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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Single stage revision ankle arthroplasty, Is it safe?
Parikshit Pekhale1, Shahzad Akhtar1, Sunil Dhar1
1Foot and Ankle Unit, Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, United Kingdom.
Background:
The number of total ankle replacements (TAR) is increasing each year and with that an associated rise in the burden of revision ankle replacement (rTAR) (Ratnamsey et al.) [3]. When a TAR fails, two options emerge: Arthrodesis or rTAR (Goldberg et al.) [1]; (Egglestone et al.) [2]; (Hinterman et al.) [4]. The preferred option in our centre following network discussion, is to convert the failing TAR to a rTAR. There is uncertainty whether this is best done in a single staged approach or two stages. The aim of this review was to assess the outcomes of single-to-two-staged approaches in rTAR, and to ascertain if there was any increase in complications or impaired outcome in the single-staged approach.
Method:
A review was carried out of the prospectively collected data of all rTAR performed in our centre between Nov 2016 and Jan 2023. We reviewed: preoperative micro-sampling, intra-op microbiology and histology results, infection rate, tourniquet time, length of hospital stay, wound complications and PROMS of all patients who had undergone a single-staged rTAR, compared to two stages.
Results:
We identified 86 rTAR patients, with a mean age of 71.4 (38-88) with a minimum of 2-year follow-up, range 2-7 years. There were 44 Left and 42 Right failing total ankle replacements. 14 were two staged procedures and 74 were single staged. No preoperative microbiology sampling was performed in the single or in the staged group. Both groups who underwent intraoperative microbiology sampling showed no positive microbiology growth. There was a significant difference in tourniquet times but with no associated significant complication rate in the single staged group versus the staged group. There was one infection in the single-staged group that went on to have a successful DAIR. There was no difference in wound complications post-op. Both groups showed improvement in PROMS, with no difference between the groups or in increase in length of hospital stay.
Conclusion:
In our series, which is the largest in the literature, we have found single-staged revision arthroplasty to be safe and effective compared to a two-stage procedure in patients where there is a low index of suspicion of infection.
Level Of Evidence:
Level III, Retrospective Cohort.
