Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina.
Campbell University School of Osteopathic Medicine, Lillington, North Carolina.
J Bone Joint Surg Am. 2022 Oct 5;104(19):1712-1721. doi: 10.2106/JBJS.22.00072. Epub 2022 Aug 24.
The risk-benefit profiles of simultaneous total ankle arthroplasty (TAA) compared with sequential TAA continue to be debated. There are limited case series reporting outcomes after bilateral TAA, with no previous comparison of simultaneous TAA with sequential TAA. Patients with bilateral pathology represent a unique population with an overall more debilitating condition. Thus, we aimed to compare bilateral simultaneous and sequential TAAs, including perioperative complications and patient-reported outcome measures.
We performed a comparative cohort study of patients who underwent primary bilateral TAA, performed in a simultaneous or sequential fashion, from 2007 to 2019 at a single academic center. Data on patient demographic characteristics, comorbidities, perioperative complications, reoperations, and implant failures were collected. Patient-reported outcome measures included preoperative and postoperative visual analog scale (VAS) scores for pain, Short Form-36 Health Survey (SF-36) scores, and Short Musculoskeletal Function Assessment (SMFA) scores.
A total of 50 patients (100 ankles) were included, with 25 patients (50 ankles) each in the bilateral simultaneous and sequential cohorts. The mean follow-up was 52.2 ± 27.3 months (range, 24 to 109 months). The mean time between sequential TAAs was 17.5 ± 20.1 months (range, 3 to 74 months). The mean patient age was 64.3 ± 10.6 years (range, 21 to 76 years), and 32 (64.0%) were men. The majority of patients (28 patients [56.0%]) had primary osteoarthritis. Both cohorts had equivalent preoperative patient-reported outcome measures and experienced improvements in all measures, which were maintained at the final follow-up with no significant between-group differences (all p > 0.05). There were no differences between the simultaneous TAA group and the sequential TAA group in perioperative complication rates (22.0% compared with 24.0%; p = 0.7788), reoperations (12.0% compared with 10.0%; p = 0.7354), 5-year reoperation-free survival (88.0% compared with 90.0%; p = 0.4612), or failure-free survival (100%). One patient in the simultaneous TAA cohort required metal component revision at 8 years postoperatively.
The patient-reported outcome measures, complications, and prosthesis survival of patients who underwent bilateral simultaneous TAA were comparable with those of patients who underwent bilateral sequential TAA. We advocate that simultaneous bilateral TAA is a safe and effective method for the treatment of bilateral end-stage ankle osteoarthritis.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
同期全踝关节置换术（TAA）与序贯 TAA 的风险-获益比仍存在争议。仅有有限的病例系列报告了双侧 TAA 后的结果，且此前并未比较同期 TAA 与序贯 TAA。双侧病变的患者代表了一个具有整体更虚弱状况的独特人群。因此，我们旨在比较双侧同期和序贯 TAA，包括围手术期并发症和患者报告的结果测量。
我们对 2007 年至 2019 年在一家学术中心接受双侧初次 TAA 的患者进行了同期或序贯双侧 TAA 的比较队列研究。收集了患者人口统计学特征、合并症、围手术期并发症、翻修和假体失败的数据。患者报告的结果测量包括术前和术后视觉模拟量表（VAS）疼痛评分、简明健康调查 36 项量表（SF-36）评分和短肢肌肉骨骼功能评估（SMFA）评分。
共纳入 50 例患者（100 例踝关节），同期双侧组和序贯双侧组各 25 例（50 例踝关节）。平均随访时间为 52.2 ± 27.3 个月（范围：24 至 109 个月）。序贯 TAA 之间的平均时间为 17.5 ± 20.1 个月（范围：3 至 74 个月）。患者平均年龄为 64.3 ± 10.6 岁（范围：21 至 76 岁），32 例（64.0%）为男性。大多数患者（28 例[56.0%]）患有原发性骨关节炎。两个队列的术前患者报告的结果测量值相当，所有测量值均有所改善，在最终随访时仍保持不变，且组间无显著差异（均 p＞0.05）。同期 TAA 组和序贯 TAA 组的围手术期并发症发生率（22.0%比 24.0%；p=0.7788）、翻修率（12.0%比 10.0%；p=0.7354）、5 年翻修无失败生存率（88.0%比 90.0%；p=0.4612）和无假体失败生存率（100%）均无差异。同期 TAA 队列中有 1 例患者在术后 8 年需要进行金属部件翻修。
接受双侧同期 TAA 的患者的患者报告结果测量、并发症和假体生存率与接受双侧序贯 TAA 的患者相当。我们主张同期双侧 TAA 是治疗双侧终末期踝关节骨关节炎的安全有效的方法。
治疗性 III 级。有关证据水平的完整描述，请参阅作者指南。
