Clement R Carter, Krynetskiy Evgeny, Parekh Selene G
Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
Foot Ankle Spec. 2013 Aug;6(4):263-70. doi: 10.1177/1938640013493463. Epub 2013 Jun 27.
Renewed interest in total ankle arthroplasty (TAA) has developed globally as a result of recent literature supporting new-generation implants as a viable alternative to arthrodesis. The literature also demonstrates a learning curve among surgeons adopting TAA. The purpose of this study is to better define this learning curve for surgeons using third-generation implants.
Charts and radiographs were reviewed for the initial 26 TAA procedures performed by the senior author. Three third-generation implants were used: SBi (Small Bone Innovations) STAR, Salto Talaris, and Wright Medical INBONE. We report perioperative and early postoperative complications.
Two perioperative fractures occurred in the first 9 cases, and the incidence subsequently dropped to 0 (P = .0431). Two cases of component malalignment occurred in the first 3 patients receiving the STAR implant, and the incidence then dropped to 0 (P = .0034). Five wound complications (4 minor and 1 major) occurred, all in the final 14 patients. No cases of nerve injury, tendon laceration, or deep vein thrombosis occurred. Two patients returned to the operating room as a result of complications, and the total perioperative and early postoperative complication rate was 27%.
The observed rate of perioperative and early postoperative complications in this case series was low relative to other similar-sized studies, suggesting that third-generation implants can reduce adverse events. Our results demonstrate that some common complications could be avoided altogether (nerve/tendon injuries), some decreased quickly with experience (intraoperative fractures and component malpositioning), and some persisted unchanged throughout this study (wound complications). These findings should influence surgical training, surgeon willingness to adopt this procedure, and patient counseling.
Therapeutic, Level IV, Retrospective Case Series.
由于近期有文献支持新一代植入物可作为关节融合术的可行替代方案，全球范围内对全踝关节置换术（TAA）的兴趣再度兴起。文献还表明，采用TAA的外科医生存在学习曲线。本研究的目的是更好地为使用第三代植入物的外科医生界定这一学习曲线。
回顾了资深作者进行的最初26例TAA手术的病历和X线片。使用了三种第三代植入物：SBi（Small Bone Innovations）STAR、Salto Talaris和Wright Medical INBONE。我们报告围手术期和术后早期并发症。
前9例中有2例围手术期骨折，随后发生率降至0（P = 0.0431）。接受STAR植入物的前3例患者中有2例出现部件排列不齐，随后发生率降至0（P = 0.0034）。发生了5例伤口并发症（4例轻微，1例严重），均发生在最后14例患者中。未发生神经损伤、肌腱撕裂或深静脉血栓形成的病例。2例患者因并发症返回手术室，围手术期和术后早期总并发症发生率为27%。
与其他规模类似的研究相比，本病例系列中观察到的围手术期和术后早期并发症发生率较低，表明第三代植入物可减少不良事件。我们的结果表明，一些常见并发症可以完全避免（神经/肌腱损伤），一些随着经验的增加而迅速减少（术中骨折和部件位置不当），还有一些在本研究中一直保持不变（伤口并发症）。这些发现应会影响外科培训、外科医生采用该手术的意愿以及患者咨询。
治疗性，IV级，回顾性病例系列。
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