SLR - January 2024 - Boettger
Title: Younger Patients Undergoing Total Ankle Arthroplasty Experience Higher Complication Rates and Worse Functional OutcomesReference: Anastasio A, Kim B, Wixted C, DeOrio J, Nunley J, Easley M, Adams S. Younger Patients Undergoing Total Ankle Arthroplasty Experience Higher Complication Rates and Worse Functional Outcomes. J Bone Joint Surg Am. Online ahead of print. 2023
Level of Evidence: Prognostic Level III
Reviewed By: Ryan Boettger, DPM
Residency Program: Scripps Mercy Hospital Podiatric Residency, San Diego, California
Podiatric Relevance: Total ankle arthroplasty (TAA) is becoming an increasingly popular procedure offered by foot and ankle surgeons. The patient selection factors such as age at time of surgery are still widely debated. Traditional opinion has stated that due to limited longevity of the implants, the procedure should be reserved for older patients. However younger patients are now increasingly being considered as candidates. There has been heterogenous data reported regarding outcomes in younger patients often with contradictory conclusions. This study presents the largest sample size to date comparing complication rates across age groups therefore adding clarity to the body of evidence on the procedure in younger patients.
Methods: This was a retrospective study conducted at a single institution by multiple surgeons reporting data on patients who received a primary TAA from March 2000 to October 2022. The authors analyzed the outcomes of 1,115 patients with at least 2 years of follow up after primary TAA. The patients were stratified into three groups according to age at the time of surgery: <55 years, between 55-70 years, and >70 years. Demographics were recorded as well as intra-operative data such as implant type and complications. Finally, post-operative complications were recorded including rates of implant failure, re-operation, polyethylene exchange, pain, and functional outcomes. Continuous data was reported at the median for each group. The mean duration of follow up was 5.6 years.
Results: Patients who were <55 years had significantly higher reoperation rates and polyethylene exchange compared to the other two groups. Additionally at final follow up the youngest cohort had higher numerical pain scores and lower FAOS functional scores at a statistically significant difference compared to the other cohorts. Finally, the younger cohort had a statistically significant higher cumulative incidence of implant failure at both the 5- and 10-year point from time of surgery.
Conclusions: This a strong study which adds clarity to the existing evidence given its large sample size and long average period of follow-up. This study strongly indicates higher complication rates and poorer outcomes for patients younger than 55 years of age. This is likely attributed to higher activity levels in younger patients and higher levels of post-traumatic arthritis as a primary indication for surgery as compared to higher rates of routine osteoarthritis in the older populations. While this is the largest study to date assessing complications across age ranges for TAA, the data is still sparce compared to that which exists for total hip and knee arthroplasty. Additionally, this is a retrospective single center study which may limit broader application of the data.