Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA.
Drexel University College of Medicine & Columbia Business School, Philadelphia, PA, USA.
Foot Ankle Int. 2021 Jun;42(6):776-787. doi: 10.1177/1071100720985292. Epub 2021 Feb 1.
The purpose of this study was to evaluate gender differences in patient outcomes and complications following total ankle replacement (TAR).
Consecutive patients who underwent primary TAR from July 2007 through May 2016 were prospectively followed and retrospectively reviewed. Demographic, operative, patient-reported outcomes (PROs), and complication data were collected and analyzed. PROs included the visual analog scale (VAS), 36-Item Short-Form Health Survey (SF-36), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale, and Short Musculoskeletal Function Assessment (SMFA). A total of 475 patients were evaluated, including 248 males (52.2%) and 227 females (47.8%) with an average of 56.8 months follow-up.
Women were more likely to have inflammatory arthritis (13.7% vs 2.8%; < .01) and significantly worse preoperative SF-36 total, SF-36 mental health component, AOFAS total, AOFAS pain, SMFA function, and SMFA bother scores (all < .05). Both genders demonstrated significant improvement in PROs at 1, 2, and 5 years. The magnitude of improvement was similar between genders for all PROs (all < .05) with the exception of SF-36 physical function, which was greater in men. Females underwent more nonrevision reoperations (32.2% vs 22.6%; = .0191), but there was no significant difference in failure rates (male 7.3% vs female 3.5%; = .07). The reoperation and failure rates at 2 years postoperation were 10.1% and 1.6% for men and 18.5% and 0.9% for women, respectively.
Women undergoing TAR were more likely to have worse preoperative PROs and higher rates of nonrevision reoperations, which remains true when controlling for their increased incidence of inflammatory arthritis. However, women reported similar improvements in PROs and had similar prosthetic survival rates as men. Increased understanding of these disparities, combined with gender-based interventions, may further advance patient outcomes.
Level III, therapeutic, retrospective comparative series.
本研究旨在评估全踝关节置换（TAR）后患者结局和并发症的性别差异。
对 2007 年 7 月至 2016 年 5 月期间接受初次 TAR 的连续患者进行前瞻性随访和回顾性研究。收集并分析患者的人口统计学、手术、患者报告的结局（PRO）和并发症数据。PRO 包括视觉模拟评分（VAS）、36 项简短健康调查问卷（SF-36）、美国矫形足踝协会（AOFAS）后足评分和短肢肌肉骨骼功能评估（SMFA）。共评估了 475 例患者，其中男性 248 例（52.2%），女性 227 例（47.8%），平均随访 56.8 个月。
女性更可能患有炎性关节炎（13.7%比 2.8%；<.01），且术前 SF-36 总分、SF-36 心理健康成分、AOFAS 总分、AOFAS 疼痛、SMFA 功能和 SMFA 烦恼评分明显更差（均<.05）。两种性别在 1、2 和 5 年时 PRO 均有显著改善。所有 PRO 改善程度在性别间相似（均<.05），除了男性的 SF-36 躯体功能评分更高。女性行更多非翻修再手术（32.2%比 22.6%；=.0191），但失败率无显著差异（男性 7.3%比女性 3.5%；=.07）。男性术后 2 年的再手术率和失败率分别为 10.1%和 1.6%，女性分别为 18.5%和 0.9%。
行 TAR 的女性术前 PRO 更差，且非翻修再手术率更高，即使考虑到其炎性关节炎发病率更高，这种情况依然存在。然而，女性报告 PRO 有相似的改善，且假体生存率与男性相似。进一步了解这些差异，并结合基于性别的干预措施，可能会进一步改善患者结局。
III 级，治疗性，回顾性比较系列。
