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      The outcomes of revision surgery for a failed ankle arthroplasty : a systematic review and meta-analysis

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          Abstract

          Aims

          Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations.

          Methods

          A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed.

          Results

          Six papers analyzed all-cause reoperations of revision ankle arthroplasties, and 14 papers analyzed failures of conversion of a TAA to fusion. It was found that 26.9% (95% confidence interval (CI) 15.4% to 40.1%) of revision ankle arthroplasties required further surgical intervention and 13.0% (95% CI 4.9% to 23.4%) of conversion to fusions; 14.4% (95% CI 8.4% to 21.4%) of revision ankle arthroplasties failed and 8% (95% CI 4% to 13%) of conversion to fusions failed.

          Conclusion

          Revision of primary TAA can be an effective procedure with improved functional outcomes, but has considerable risks of failure and reoperation, especially in those with periprosthetic joint infection. In those who undergo conversion of TAA to fusion, there are high rates of nonunion. Further comparative studies are required to compare both operative techniques.

          Cite this article: Bone Jt Open 2022;3(7):596–606.

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          Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature.

          S Haddad, J. Coetzee, R Estok … (2007)
          The efficacy of total ankle replacement compared with that of ankle fusion continues to be one of the most debated topics in foot and ankle surgery. The purpose of this study was to determine whether there are sufficient objective cumulative data in the literature to compare the two procedures. A systematic review of the literature addressing the intermediate and long-term outcomes of interest in total ankle arthroplasty and ankle arthrodesis was performed. A comprehensive search of MEDLINE for all relevant articles published in English from January 1, 1990, to March 2005 was conducted. Additionally, relevant abstracts from the 2003 and 2004 annual proceedings of major orthopaedic meetings were eligible. Two reviewers evaluated each study to determine whether it was eligible for inclusion and collected the data of interest. Meta-analytic pooling of group results across studies was performed for the two procedures. The analysis of the outcomes focused on second-generation ankle implants. The systematic review identified forty-nine primary studies, ten of which evaluated total ankle arthroplasty in a total of 852 patients and thirty-nine of which evaluated ankle arthrodesis in a total of 1262 patients. The mean AOFAS (American Orthopaedic Foot and Ankle Society) Ankle-Hindfoot Scale score was 78.2 points (95% confidence interval, 71.9 to 84.5) for the patients treated with total ankle arthroplasty and 75.6 points (95% confidence interval, 71.6 to 79.6) for those treated with arthrodesis. Meta-analytic mean results showed 38% of the patients treated with total ankle arthroplasty had an excellent result, 30.5% had a good result, 5.5% had a fair result, and 24% had a poor result. In the arthrodesis group, the corresponding values were 31%, 37%, 13%, and 13%. The five-year implant survival rate was 78% (95% confidence interval, 69.0% to 87.6%) and the ten-year survival rate was 77% (95% confidence interval, 63.3% to 90.8%). The revision rate following total ankle arthroplasty was 7% (95% confidence interval, 3.5% to 10.9%) with the primary reason for the revisions being loosening and/or subsidence (28%). The revision rate following ankle arthrodesis was 9% (95% confidence interval, 5.5% to 11.6%), with the main reason for the revisions being nonunion (65%). One percent of the patients who had undergone total ankle arthroplasty required a below-the-knee amputation compared with 5% in the ankle arthrodesis group. On the basis of these findings, the intermediate outcome of total ankle arthroplasty appears to be similar to that of ankle arthrodesis; however, data were sparse. Comparative studies are needed to strengthen this conclusion.
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            What is a revision of total ankle replacement?

            Urban Rydholm, Åke Carlsson, Anders Henricson (2011)
            Article 0 comments Cited 21 times – based on 0 reviews     Review now
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              Ankle arthrodesis for failed total ankle replacement.

              P Hopgood, R Kumar, P L R Wood (2006)
              Between 1999 and 2005, 23 failed total ankle replacements were converted to arthrodeses. Three surgical techniques were used: tibiotalar arthrodesis with screw fixation, tibiotalocalcaneal arthrodesis with screw fixation, and tibiotalocalcaneal arthrodesis with an intramedullary nail. As experience was gained, the benefits and problems became apparent. Successful bony union was seen in 17 of the 23 ankles. The complication rate was higher in ankles where the loosening had caused extensive destruction of the body of the talus, usually in rheumatoid arthritis. In this situation we recommend tibiotalocalcaneal arthrodesis with an intramedullary nail. This technique can also be used when there is severe arthritic change in the subtalar joint. Arthrodesis of the tibiotalar joint alone using compression screws was generally possible in osteoarthritis because the destruction of the body of the talus was less extensive. Tibiotalocalcaneal arthrodesis fusion with compression screws has not been successful in our experience.
              Article 0 comments Cited 20 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Toby Jennison:
                ORCID: https://orcid.org/0000-0001-7517-4556
                Role: National Joint Registry Research Fellow
                Claire Spolton-Dean: Role: Speciality Registrar
                Hannah Rottenburg: Role: Junior Doctor
                Obioha Ukoumunne: Role: Professor
                Ian Sharpe: Role: Consultant Orthopaedic Surgeon
                Andrew Goldberg: Role: Consultant Orthopaedic Surgeon
                Journal
                Journal ID (nlm-ta): Bone Jt Open
                Journal ID (iso-abbrev): Bone Jt Open
                Journal ID (publisher-id): BJO
                Title: Bone & Joint Open
                Publisher: The British Editorial Society of Bone & Joint Surgery (London )
                ISSN (Electronic): 2633-1462
                Publication date (Electronic): 28 July 2022
                Publication date Collection: July 2022
                Volume: 3
                Issue: 7
                Pages: 596-606
                Affiliations
                [1 ] org-divisionRoyal Devon and Exeter NHS Foundation Trust , Exeter, UK
                [2 ] org-divisionUniversity of Exeter , Exeter, UK
                [3 ] org-divisionWellington Hospital , London, UK
                Author notes
                Correspondence should be sent to Toby Jennison. E-mail: toby.jennison@ 123456nhs.net
                Author information
                https://orcid.org/0000-0001-7517-4556
                Article
                Publisher ID: BJO-3-596
                DOI: 10.1302/2633-1462.37.BJO-2022-0038.R1
                PMC ID: 9350690
                PubMed ID: 35880516
                SO-VID: 7804f4ec-a912-4d5a-a11a-abcfa1feed83
                Copyright © © 2022 Author(s) et al.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/

                History
                Categories
                Subject: Systematic Review
                Subject: Total Disc Replacement
                Subject: Anterior Cervical Discectomy and Fusion
                Subject: Degenerative Spine Disease
                Subject: Meta-Analysis
                Subject: Systematic Review
                Compound subject: bj11416, Orthopaedic treatments
                Compound subject: bj1268, Arthroplasty
                Compound subject: bj11388, Orthopaedic diseases
                Compound subject: bj1763, Basic science
                Compound subject: bj801, Ankle arthroplasty
                Compound subject: bj14005, Revision surgeries
                Compound subject: bj14006, Revision total ankle arthroplasty
                Compound subject: bj17248, Total ankle arthroplasty
                Compound subject: bj12334, Periprosthetic joint infection
                Compound subject: bj11128, Nonunion
                Compound subject: bj674, Amputations
                Compound subject: bj6217, Functional outcome score
                Compound subject: bj13175, Primary total ankle arthroplasty
                Compound subject: bj15988, Surgical treatment
                Custom metadata
                odf2nlm-version 2.0
                price $2.00
                principal-institution Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
                article-type Systematic Review
                coi-statement A. Goldberg reports a grant from NIHR HTA, consulting fees from P28, and speaker fees and travel expenses from Stryker, all unrelated to this study. A. Goldberg is on the National Joint Registry Medical Advisory Committee and Editorial Committee, as well as the FAI/FAO Editorial Board and BOFAS Outcomes Committee. I. Sharpe reports consulting fees, travel expenses, and lecture payments from Stryker, unrelated to this study.

                Keywords: ankle replacement,revision ankle replacement,ankle arthrodesis,ankle arthroplasties,revision surgery,revision total ankle arthroplasty,total ankle arthroplasty (taa),periprosthetic joint infection,nonunion,amputations,functional outcomes,primary total ankle arthroplasty,surgical treatment
                Data availability:
                Keywords: ankle replacement, revision ankle replacement, ankle arthrodesis, ankle arthroplasties, revision surgery, revision total ankle arthroplasty, total ankle arthroplasty (taa), periprosthetic joint infection, nonunion, amputations, functional outcomes, primary total ankle arthroplasty, surgical treatment

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