SLR - February 2024 - Crenshaw
Title: Total Ankle Arthroplasty for Posttraumatic Fracture Versus Primary Osteoarthritis: An Analysis of Complications, Revisions, and Prosthesis SurvivalReference: Megerian MF, Harlow ER, LaTulip SM, Zhao C, Ina JG, Sattar A, Feighan JE. Total Ankle Arthroplasty for Posttraumatic Fracture Versus Primary Osteoarthritis: An Analysis of Complications, Revisions, and Prosthesis Survival. J Am Acad Orthop Surg. 2023 Jul 15;31(14):727-737. doi: 10.5435/JAAOS-D-22-01192. Epub 2023 Apr 19. PMID: 37079718.
Level of Evidence: III
Scientific Literature Review
Reviewed By: Keith Crenshaw, DPM, MS
Residency Program: Mount Auburn Hospital, Cambridge, MA
Podiatric Relevance: Total ankle arthroplasty (TAA) has been utilized by many Podiatric surgeons for treatment of ankle osteoarthritis. There has been little research that investigates the difference in complications, revisions and implant survival when comparing the etiology of osteoarthritis. This article investigates the complications for TAA between preoperative primary osteoarthritis and posttraumatic osteoarthritis.
Methods: 99 patients were retrospectively evaluated with a mean follow up of 3.2 years. Preoperative diagnosis with primary osteoarthritis and posttraumatic arthritis was 44 and 55 patients, respectively. Posttraumatic arthritis was categorized by fracture type. Additionally, preoperative coronal plane alignment, postoperative complications, revisions, and explanation of prosthesis were evaluated. All TAAs were performed using the Scandinavian Total Ankle Replacement (STAR) prosthesis.
Results: Complication rate was significantly greater in the posttraumatic arthritis population. No difference was observed in rates of any specific complication by etiology. Survivorship with failure, defined as prosthesis explant, showed a significant difference between the POA (100%) and fracture PTOA (89%) groups (P = 0.03). Within the posttraumatic arthritis cohort, pilon fractures were associated with higher rates of talar implant subsidence and loosening. Preoperative coronal plane alignment in valgus was found to have a significant increase in both revision surgery and prosthesis explant. There was greater association of valgus deformity in the posttraumatic arthritis population.
Conclusions: Higher complication rates were found to be associated with posttraumatic arthritis patients secondary to fracture. Those patients with a TAA performed after developing posttraumatic arthritis had a higher risk of revision surgery and prosthesis explant, which was associated with valgus malalignment preoperatively. Due to the higher risk of revisional surgery and prosthesis explant following posttraumatic arthritis, it is important to consider the effects of the coronal plane on a 3-piece mobile bearing total ankle system like the STAR. Additionally, this article shows a greater association with talar component subsidence and loosening in patients who had posttraumatic arthritis with a pilon fracture. The STAR prosthesis talar bone cuts should be further evaluated, as the technique specific bone cuts could contribute to loss of talar bone, which has the potential for additional risk of subsidence incidence in this population. It will be important to evaluate this comparison between primary osteoarthritis and posttraumatic arthritis complications with other TAA systems such as those with a stemmed tibial component that can compensate for the coronal plane deformity, along with those with minimal bone cuts to the talus for evaluation of subsidence and loosening. A limitation is that concomitant procedures where not discussed in this article as they could contribute to the survivorship of the TAA with improvement in coronal plane alignment.