Abstract
Category:
Ankle Arthritis; Ankle
Introduction/Purpose:
As Total Ankle Arthroplasty (TAA) volume continues to grow nationally, so is the need for revision TAA surgery. A foot and ankle surgeon fresh out of fellowship is likely to encounter these challenging cases soon after beginning practice. The learning curve for ankle replacement has been demonstrated in multiple studies but no such study exists for revision TAA due to the relative infrequency of this procedure. The experience of one high volume revision TAA surgeon in the first two years after fellowship is reviewed in this study. Radiographic, clinical, and patient reported outcomes are analyzed in this study.
Methods:
In this IRB approved study, we retrospectively reviewed prospectively collected data on 18 patients who underwent Revision Total Ankle Arthroplasty Surgery from January 1, 2018, to January 1, 2021. Patient-reported outcome (PRO) measures including PROMIS depression, physical function and pain interference CATs taken preoperatively and then at specific post- operative intervals were collected on all patients. Radiographic and clinical results were also reviewed. Patients being revised, whether single stage or two-stage, for infection were excluded. Patients converted from ankle arthrodesis to ankle replacement were omitted. Student t tests, chi-square test, and nonparametric alternatives (p <.05) we used.
Results:
Eighteen patients ( Average age 65.5, 50% male) underwent revision TAA average follow up 25 months. Aseptic loosening (50%) was the most common cause for revision followed by component malpositioning (28.8%). The Scandanavian Total Ankle Replacement was the most commonly revised implant in this study 83.3%. Radiographic parameters (Tibiotalar angle Tibial component positioning) improved after revision TAA. Average Promis physical function improved from 41.18 pre-op to 47.77 (p.078), depression improved from 57.64 pre-op to 49.67(p .025*), and pain interference improved from 61.3 preop to 50.55 (p .045*) after revision TAA. No differences were seen in any outcome measure with regards to time from fellowship, when assessing for a learning curve. See attached table for complete list of results.
Conclusion:
Revision TAA is a technically challenging procedure. One which will continue to be more and more common as ankle replacement continues to replace arthrodesis as the preferred treatment for ankle arthritis. This study did not identify a learning curve for revision total ankle arthroplasty. Outcomes were similar independent of time after fellowship the cases occurred.
Patient reported outcomes, clinical outcomes, and radiographic outcomes all improved in this cohort after revision TAA.
