SLR - October 2022 - Anne He, DPM
Reference: Randsborg PH, Jiang H, Mao J, Devlin V, Marinac-Dabic D, Peat R, Sedrakyan A. Two-Year Revision Rates in Total Ankle Replacement Versus Ankle Arthrodesis: A Population-Based Propensity-Score-Matched Comparison from New York State and California. JBJS Open Access: April-June 2022 - Volume 7 - Issue 2 - e21.00136Level of Evidence: III
Scientific Literature Review
Reviewed By: Anne He, DPM
Residency Program: Scripps Mercy Hospital -- San Diego, CA
Podiatric Relevance: Total ankle replacement (TAR), which was introduced back in the 1970s have been an alternative for ankle arthrodesis (AA) for end-stage osteoarthritis of the ankle joint. Current literature shows that the 5-year revision rates were >15% for TAR, which is higher when compared to hip and knee replacements. Due to the increase in popularity of TAR, there is still no consensus as to TAR vs AA is a superior intervention. This present study aims to compare risk and predictors of early revision (within 2 years) after primary TAR and AA.
Methods: A data search for patients who underwent primary TAR or AA in New York and California using the ICD-10 from October 2015 to December 2018 via the New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) and California Office of Statewide Health Planning and Development (OSHPD). Exclusion criteria included <22 years old, non-primary procedure, non-CA or non-NYC residents, and TAR without rheumatic, traumatic or osteoarthritic indications. New York search yielded 616 TAR, 624 AA; California search yielded 861 TAR, 844 AA. The primary outcome is revision after the index TAR and AA procedures. Secondary outcomes included in hospital complications (wound complications, DVT, postoperative infection, or neurovascular injury) and below knee amputations.
Results:
• A total of 2,945 patients were >22 years of age underwent a primary TAR (n = 1,477, 50.2%) or AA procedure (n = 1,468, 49.8%) in New York State and California.
• TAR group were older than the AA group (mean age of 65.5 versus 58.3 years; p < 0.001).
• TAR recipients had a significantly lower risk of revision (5.4% versus 9.1%; p < 0.001), in-hospital complications (<1% versus 1.8%; p < 0.001), and below-the-knee amputation (<1% versus 4.9%; p < 0.001) compared with AA patients.
• After propensity score matching, there was no significant difference in gender, race/ethnicity, insurance, state, indications, or specific comorbidities.
• Age and sex were predictive of revision risk for TAR and AA respectively. Older patients were predictor of lower revision risk in the TAR group. Women were less likely to have revision after AA.
Conclusions: Authors concluded that there was no significant difference in 2-year revision risk between TAR (5.6%) and AA (7.6%) after propensity-score matching. They did find that the risk factors for revision after a TAR are younger patients, and men had a higher risk of revision after AA. Ankle arthrodesis have a wider range of indications than TAR, but with the conclusion extrapolated from this present study, I would highly consider TAR in older patients which typically have lower physical demands. Various comorbidities amongst the two groups were found to have no significant differences; therefore, I would be less reluctant to do TARs in patients with multiple comorbidities. However, I would appreciate a more specific study for further investigation.