Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Division of Orthopaedic Surgery, Unity Health Network-St. Michael's Hospital, Toronto, Ontario, Canada.
J Bone Joint Surg Am. 2022 Feb 2;104(3):221-228. doi: 10.2106/JBJS.21.00287.
We investigated the influence of sex on patient-reported outcomes preoperatively and following total ankle replacement and ankle arthrodesis.
Patients who had undergone total ankle replacement or ankle arthrodesis for the treatment of end-stage ankle arthritis and who had ≥2 years of follow-up were identified from the Canadian Orthopaedic Foot and Ankle Society Prospective Ankle Reconstruction Database. Standard surgical techniques and implantation methods were followed, and STAR, Hintegra, Mobility, and Agility prostheses were used. Data were collected on patient demographics, revisions, secondary procedures, complications, Ankle Osteoarthritis Scale (AOS) scores, Short Form-36 (SF-36) scores, and expectations and satisfaction. Statistical analyses included 3-way repeated-measures analysis of variance (ANOVA) and multiple linear regression models controlling for inflammatory arthritis, age, preoperative scores, and surgery type.
The study included 872 patients: 629 who had undergone total ankle replacement (316 men, 313 women) and 243 who had undergone ankle arthrodesis (154 men, 89 women). The mean duration of follow-up (and standard deviation) was 4.9 ± 2.4 and 4.0 ± 1.9 years for the total ankle replacement and ankle arthrodesis groups, respectively. Men were older than women (p ≤ 0.001). In both the total ankle replacement and ankle arthrodesis groups, women had higher AOS pain scores (i.e., more pain) than men preoperatively (p < 0.05). Pain was reduced significantly in both sexes postoperatively (p < 0.05), with no significant difference between sexes. In both the total ankle replacement and ankle arthrodesis groups, women had higher AOS disability scores (i.e., more disability) and lower SF-36 Physical Component Summary (PCS) scores (i.e., worse function) than men both preoperatively and postoperatively (p < 0.001). Postoperatively, AOS disability and SF-36 PCS scores improved significantly from baseline in both sexes (p < 0.001). After controlling for covariates, sex was not a significant predictor of postoperative SF-36 MCS (Mental Component Summary), AOS pain, or AOS disability scores (p > 0.05) but explained 0.5% of variance in SF-36 PCS scores (p = 0.03). Sex did not significantly influence preoperative expectations or postoperative satisfaction. When patients with inflammatory arthritis were excluded, preoperative and postoperative outcome measures, expectations, and satisfaction were similar.
Men and women with end-stage ankle arthritis benefited from total ankle replacement and ankle arthrodesis with similar magnitudes of improvement. Small differences in pain and function between men and women undergoing total ankle replacement and ankle arthrodesis mostly disappeared when controlling for potential confounding variables. Both total ankle replacement and ankle arthrodesis remain good options for men and women with end-stage ankle arthritis.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
我们研究了性别对全踝关节置换和踝关节融合术前及术后患者报告结局的影响。
从加拿大矫形足踝协会前瞻性踝关节重建数据库中确定了因终末期踝关节关节炎接受全踝关节置换或踝关节融合术治疗且随访时间≥2 年的患者。采用标准手术技术和植入方法，使用 STAR、Hintegra、Mobility 和 Agility 假体。收集患者人口统计学资料、翻修、二次手术、并发症、踝关节骨关节炎量表（AOS）评分、简明 36 健康调查量表（SF-36）评分、预期和满意度。统计分析包括 3 因素重复测量方差分析（ANOVA）和多元线性回归模型，控制炎症性关节炎、年龄、术前评分和手术类型。
本研究纳入 872 例患者：629 例行全踝关节置换（男 316 例，女 313 例），243 例行踝关节融合术（男 154 例，女 89 例）。全踝关节置换和踝关节融合术组的平均随访时间（标准差）分别为 4.9±2.4 年和 4.0±1.9 年。男性比女性年龄更大（p≤0.001）。在全踝关节置换和踝关节融合术组中，女性术前 AOS 疼痛评分（即疼痛程度）均高于男性（p<0.05）。术后两组患者疼痛均明显减轻（p<0.05），且性别间无差异。在全踝关节置换和踝关节融合术组中，女性术前 AOS 功能评分（即功能障碍程度）和 SF-36 生理成分量表（PCS）评分（即功能状态）均低于男性（p<0.001）。术后两组患者 AOS 功能和 SF-36 PCS 评分均较基线显著改善（p<0.001）。校正协变量后，性别不是术后 SF-36 心理健康量表（MCS）、AOS 疼痛或 AOS 功能评分的显著预测因素（p>0.05），但解释了 SF-36 PCS 评分 0.5%的变异（p=0.03）。性别并未显著影响术前预期或术后满意度。排除炎症性关节炎患者后，术前和术后结局指标、预期和满意度相似。
终末期踝关节关节炎男性和女性接受全踝关节置换和踝关节融合术均能获得相似程度的改善。在控制潜在混杂因素后，全踝关节置换和踝关节融合术患者中男性和女性之间的疼痛和功能的小差异大多消失。全踝关节置换和踝关节融合术仍是终末期踝关节关节炎男性和女性的良好选择。
治疗性 IV 级。有关证据水平的完整描述，请参见作者说明。
