Pangrazzi Garett J, Baker Erin A, Shaheen Phillip J, Okeagu Chikezie N, Fortin Paul T
1 Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, MI, USA.
2 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA.
Foot Ankle Int. 2018 Jan;39(1):46-58. doi: 10.1177/1071100717735288. Epub 2017 Oct 16.
Total ankle arthroplasty (TAA) has historically resulted in inferior survivorship rates compared with total hip and knee arthroplasty, because of technical issues unique to ankle anatomy. In this study, a single-surgeon series of intra- and postoperative complications as well as resultant reoperations/revisions of the Tornier Salto Talaris, a fixed-bearing TAA prosthesis, were reviewed.
Medical records from index procedure to latest follow-up of primary TAA were reviewed. Complications were categorized according to the Glazebrook classification; additional complications were documented. Concurrent procedures were recorded, and radiographs were analyzed for alignment, subsidence, and cyst formation. Time to complication onset and learning curve analyses were performed. One hundred four Salto Talaris TAA prostheses (96 patients), with an average follow-up of 46 months, were included.
Thirty-five complications were identified in 32 ankles with a 34% complication rate, resulting in 11 reoperations (5 TAA revisions). Technical error (n = 12), wound healing (n = 9), and aseptic loosening (n = 4) were the most common complications, and there were no statistically significant differences in demographics or follow-up duration between cases with versus without complications. In both the cohorts with and without complications, there were moderate, negative correlations between radiographically observed keel osteopenia and lucency (ρ = -0.548, P = .00125, and ρ = -0.416, P = .000303, respectively); also, in the complication cohort, a weak, positive correlation between subsidence and lucency (ρ = 0.357, P = .0450) was found.
Salto Talaris TAA survivorship and reoperation rates in our series were comparable with previous reports, using either the same or similar mobile-bearing prostheses; new information regarding complication, radiographic, and learning curve analyses was presented.
Level IV, retrospective case series.
由于踝关节解剖结构所特有的技术问题，与全髋关节置换术和全膝关节置换术相比，全踝关节置换术（TAA）在历史上的生存率较低。在本研究中，回顾了由单一外科医生进行的一系列Tornier Salto Talaris固定承重TAA假体的术中及术后并发症以及由此导致的再次手术/翻修情况。
回顾了从初次手术到初次TAA最新随访的病历。并发症根据Glazebrook分类进行分类；记录额外的并发症。记录同期进行的手术，并分析X线片的对线、下沉和囊肿形成情况。进行并发症发生时间和学习曲线分析。纳入104例Salto Talaris TAA假体（96例患者），平均随访46个月。
在32例踝关节中发现35例并发症，并发症发生率为34%，导致11例再次手术（5例TAA翻修）。技术失误（n = 12）、伤口愈合（n = 9）和无菌性松动（n = 4）是最常见的并发症，有并发症和无并发症病例在人口统计学或随访时间上无统计学显著差异。在有并发症和无并发症的队列中，X线观察到的龙骨骨质减少与透亮区之间均存在中度负相关（分别为ρ = -0.548，P = 0.00125和ρ = -0.416，P = 0.000303）；此外，在并发症队列中，下沉与透亮区之间存在弱正相关（ρ = 0.357，P = 0.045）。
我们系列中的Salto Talaris TAA生存率和再次手术率与之前使用相同或类似活动承重假体的报告相当；提供了有关并发症、影像学和学习曲线分析的新信息。
IV级，回顾性病例系列。
