Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria 3128, Australia.
Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria 3128, Australia; Department of Surgery, The University of Melbourne, Parkville, Victoria 3010, Australia.
Foot Ankle Surg. 2020 Jul;26(5):556-563. doi: 10.1016/j.fas.2019.07.006. Epub 2019 Jul 25.
Total ankle arthroplasty (TAA) is increasingly gaining recognition as an alternative to ankle arthrodesis in the treatment of end-stage ankle arthritis. Despite high rates of adverse events during early inception, newer generations of uncemented prosthesis and design modifications have improved outcomes. Questions remain regarding the long-term outcomes and implant survivorship of TAA.
This analysis aims to establish an updated review of intermediate and long-term clinical outcome and complication profile of TAA.
A multi database search was performed on 14th October 2018 according to PRISMA guidelines. All articles that involved patients undergoing uncemented TAA with 5 years minimum follow-up, reported clinical outcome or complication profile of TAA were included. Seventeen observational studies were included in the review, with 1127 and 262 ankles in the 5 and 10 years minimum follow-up groups respectively.
Mean difference between pre- and post-operative AOFAS score was 43.60 (95%CI: 37.51-49.69, p<0.001) at 5 years minimum follow-up. At 5 years minimum follow-up, pooled proportion (PP) of prostheses revision for any reason other than polyethylene exchange was 0.122 (95%CI: 0.084-0.173), all cause revision was 0.185 (95%CI: 0.131-0.256), unplanned reoperation was 0.288 (95%CI: 0.204-0.390) and all infection was 0.033 (95%CI: 0.021-0.051). At 10 years minimum follow-up, PP of prostheses revision for any reason other than polyethylene exchange was 0.202 (95%CI: 0.118-0.325), all cause revision was 0.305 (95%CI: 0.191-0.448), unplanned reoperation was 0.422 (95%CI: 0.260-0.603) and all infection was 0.029 (95%CI: 0.013-0.066).
Despite good intermediate and long-term functional outcome measures, TAA has relatively higher revision surgery prevalence with longer follow-up periods. Further research should be directed towards identifying patient populations that would best benefit from TAA and those at greatest risk of requiring revision surgery.
全踝关节置换术（TAA）作为治疗晚期踝关节关节炎的一种替代方法，在踝关节融合术方面越来越受到认可。尽管在早期应用中存在较高的不良事件发生率，但新一代非骨水泥假体和设计改良提高了手术效果。关于 TAA 的长期临床结果和假体存活率问题仍存在疑问。
本分析旨在对 TAA 的中期和长期临床结果及并发症情况进行最新的综述。
根据 PRISMA 指南，于 2018 年 10 月 14 日在多个数据库中进行了检索。纳入所有涉及接受非骨水泥 TAA 且随访时间至少 5 年、报告 TAA 临床结果或并发症情况的患者的文章。本综述纳入了 17 项观察性研究，其中 5 年和 10 年最小随访组分别有 1127 例和 262 例踝关节。
5 年最小随访时，AOFAS 评分术前与术后的平均差值为 43.60（95%CI：37.51-49.69，p<0.001）。5 年最小随访时，因非聚乙烯置换以外的任何原因进行假体翻修的汇总比例（PP）为 0.122（95%CI：0.084-0.173），全因翻修的 PP 为 0.185（95%CI：0.131-0.256），计划外再手术的 PP 为 0.288（95%CI：0.204-0.390），所有感染的 PP 为 0.033（95%CI：0.021-0.051）。10 年最小随访时，因非聚乙烯置换以外的任何原因进行假体翻修的 PP 为 0.202（95%CI：0.118-0.325），全因翻修的 PP 为 0.305（95%CI：0.191-0.448），计划外再手术的 PP 为 0.422（95%CI：0.260-0.603），所有感染的 PP 为 0.029（95%CI：0.013-0.066）。
尽管 TAA 的中期和长期功能测量结果良好，但随着随访时间的延长，TAA 的翻修手术发生率相对较高。应进一步开展研究，以确定哪些患者群体最适合接受 TAA 治疗，以及哪些患者最有可能需要进行翻修手术。
