SLR- November 2022- Jacob Harder, DPM
Title: Clinical Outcomes and Complications of Simultaneous or Sequential Bilateral Total Ankle ArthroplastyReference: Fletcher AN, Johnson LG, Easley ME, Nunley JA, DeOrio JK; A Single-Center Comparative Cohort Study. Clinical Outcomes and Complications of Simultaneous or Sequential Bilateral Total Ankle Arthroplasty. J Bone Joint Surg Am. 2022 Aug 24.
Level of Evidence: III
Scientific Literature Review
Reviewed By: Jacob Harder, DPM PGY3
Residency Program: Ascension Wisconsin Hospital, Milwaukee, WI
Podiatric Relevance: Total ankle arthroplasty (TAA) utilization and indications continue to expand and over the past decade, the profession has seen their implantation increase substantially. In patients with bilateral ankle pathology where TAA is indicated, patents are often treated with sequential procedures. Bilateral simultaneous TAA remains controversial and has yet to be extensively investigated.
Methods: This was a retrospective review of prospectively collected data including patients undergoing a primary bilateral TAA in a simultaneous (performed by 2 surgeons at the same time) or sequential (1 surgeon performing 2 separate procedures, minimum 3 months in between) manner from September 2007-2019. The procedures were performed by 1 of 3 of the above listed authors. Exclusion criteria included history of ankle arthrodesis, revision TAA, talar osteonecrosis, infection, and <2 years follow up. Indications for simultaneous TAA was a multifactorial, subjective decision made by the physician and the patient based on patient age, comorbidities, self-motivation, social support, adequate bone quality, and no concomitant procedures necessary that would require non-weightbearing post-operatively. Patient reported outcomes were measured including VAS, SF-36, SMFA function scores, and SMFA bother scores. Perioperative complications were also recorded.
Results: The study included a total of 50 patients (100 ankles) each equally divided into each group. No difference in pre-operative and post-operative patient reported outcomes between groups at 1 year. Both groups showed significant improvements in scores at 1 year and at final follow up. A total of 23 ankles (11 in the simultaneous cohort; 12 in the sequential cohort) encountered at least 1 postoperative complication with 11 (6 in the simultaneous cohort; 5 in the sequential cohort) requiring a reoperation. There was no significant difference between cohorts when comparing complications and reoperations. The reoperation-free survival was 96% at 2 years and 90% at 5 years for the sequential TAA cohort and 94% at 2 years and 88% at 5 years for the simultaneous TAA cohort. Both were 100% failure-free survival up to 8 years post-operatively.
Conclusions: Patients undergoing bilateral simultaneous TAA have similar patient reported outcomes, complications, and component survival as compared to patients undergoing bilateral sequential TAA. If patients are carefully and appropriately selected, simultaneous bilateral TAA is a safe and effective method for treatment of bilateral ankle pathology. The potential benefits of simultaneous TAA include decreased anesthesia, operative time, tourniquet time, length of hospitalization, recovery, rehabilitation time, and overall cost, however these benefits warrant further investigation.