Roukis Thomas S
Department of Orthopaedics, Podiatry, and Sports Medicine, Gundersen Lutheran Healthcare System, La Crosse, WI, USA.
J Foot Ankle Surg. 2012 Mar-Apr;51(2):198-204. doi: 10.1053/j.jfas.2011.11.002. Epub 2011 Dec 20.
Revision of failed total ankle replacement remains a challenge with limited information available to guide treatment options. I undertook a systematic review of electronic databases and other relevant sources to identify material relating to the incidence of revision after primary implantation of the Agility™ Total Ankle Replacement System. In an effort to procure the highest quality studies available, studies were eligible for inclusion only if they involved patients undergoing primary Agility™ Total Ankle Replacement; had evaluated patients at a mean follow-up of 12 months or longer; included details of the revision performed; and included revision etiologies of aseptic loosening, ballooning osteolysis, cystic changes, malalignment, or instability. A total of 14 studies involving 2312 ankles, with a weighted mean follow-up of 22.8 months, were included. Of the 2312 ankles, 224 (9.7%) underwent revision, of which 182 (81.3%) underwent implant component replacement, 34 (15.2%) underwent arthrodesis, and 8 (3.6%) underwent below-knee amputation. No significant effect from the surgeon's learning curve on the incidence of revision or the type of revision surgery performed was identified. However, excluding the inventor increased the incidence of revision twofold, from 6.6% to 12.2%, and skewed the type of revision away from arthrodesis and toward implant component replacement or below-knee amputation. Regardless, the incidence of revision after primary implantation of the Agility™ Total Ankle Replacement System was less than historically reported and amenable to implant component revision more than 80% of the time. However, methodologically sound cohort studies are needed that include the outcomes after revision surgery, specifically focusing on what implant component replacement techniques are effective in enhancing survivorship of these revised implants and the role of custom-stemmed talar and tibial components have in revision of the Agility™ Total Ankle Replacement System. A direct comparison of the incidence of revision between the various contemporary total ankle replacement systems in common use is also warranted.
翻修失败的全踝关节置换术仍然是一项挑战，目前可用于指导治疗方案的信息有限。我对电子数据库和其他相关来源进行了系统回顾，以确定与Agility™全踝关节置换系统初次植入后翻修发生率相关的资料。为了获取现有最高质量的研究，只有符合以下条件的研究才纳入：研究对象为接受Agility™全踝关节置换术的患者；平均随访时间为12个月或更长时间对患者进行评估；包括所进行翻修的详细情况；包括无菌性松动、膨胀性骨溶解、囊性改变、排列不齐或不稳定等翻修病因。共纳入14项研究，涉及2312例踝关节，加权平均随访时间为22.8个月。在这2312例踝关节中，224例（9.7%）接受了翻修，其中182例（81.3%）进行了植入部件置换，34例（15.2%）进行了关节融合术，8例（3.6%）进行了膝下截肢术。未发现外科医生的学习曲线对翻修发生率或所进行的翻修手术类型有显著影响。然而，排除发明者后，翻修发生率增加了一倍，从6.6%增至12.2%，并且翻修类型从关节融合术偏向植入部件置换或膝下截肢术。无论如何，Agility™全踝关节置换系统初次植入后的翻修发生率低于既往报道，并且超过80%的情况适合进行植入部件翻修。然而，需要进行方法学上合理的队列研究，包括翻修手术后的结果，特别关注哪些植入部件置换技术能有效提高这些翻修植入物的生存率以及定制柄距骨和胫骨部件在Agility™全踝关节置换系统翻修中的作用。对各种常用的当代全踝关节置换系统之间的翻修发生率进行直接比较也是必要的。
