Kim Jaeyoung, Rajan Lavan, Fuller Robert, O'Malley Martin, Levine David, Deland Jonathan, Ellis Scott, Demetracopoulos Constantine
Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
Hospital for Special Surgery, 420 E 72nd St Ground Floor, New York, NY 10021, United States.
Foot Ankle Surg. 2022 Dec;28(8):1463-1467. doi: 10.1016/j.fas.2022.08.012. Epub 2022 Sep 5.
Despite a significant reported rate of non-revision reoperation after total ankle arthroplasty (TAA), it is uncertain if these subsequent procedures have an impact on the longer term outcomes. This study aimed to compare minimum five-year functional outcomes of patients who had undergone reoperation after TAA to those who did not require reoperation.
Seventy-six ankles (74 patients) who underwent TAA with the Salto Talaris fixed bearing system between 2007 and 2014 were allocated into two groups based on presence (n = 16) or absence of reoperation (n = 60). Reoperations included all secondary procedures after index TAA, excluding revision surgeries requiring removal or exchange of the original prosthesis. The foot and ankle outcome score (FAOS) at preoperative and minimum five-year follow-up was compared between the groups. Additionally, improvements in FAOS subscales were compared. Preoperative deformity, postoperative implant alignment, number of periprosthetic cysts, and subsidence between groups were compared using standard weightbearing radiographs.
The most common cause of reoperation was gutter impingement (n = 11), followed by stress fracture of the medial malleolus (n = 2), tarsal tunnel syndrome (n = 1), periprosthetic cyst (n = 1), and infection (n = 1). In comparison to the non-reoperation group, all FAOS subscales except for the Sports and Recreational Activities subscale were significantly lower in the reoperation group at final follow-up. The reoperation group exhibited significantly less improvement in the Pain, Symptoms, and Quality of Life subscales at final follow-up (p < 0.05). There were no statistical differences in the radiographic parameters between both groups.
Patients who underwent reoperation after TAA demonstrated inferior functional outcomes at mid-term follow-up. An emphasis should be placed on preventing possible causes of reoperations to achieve favorable patient outcomes. Additionally, if a reoperation is deemed necessary, a thorough evaluation and surgical correction of underlying causes should be achieved.
尽管全踝关节置换术（TAA）后报道的非翻修再次手术率较高，但这些后续手术是否会对长期疗效产生影响尚不确定。本研究旨在比较TAA术后接受再次手术的患者与未接受再次手术的患者至少五年的功能结局。
2007年至2014年间采用Salto Talaris固定承重系统接受TAA的76例踝关节（74例患者）根据是否接受再次手术（n = 16）或未接受再次手术（n = 60）分为两组。再次手术包括初次TAA后的所有二次手术，不包括需要移除或更换原假体的翻修手术。比较两组术前和至少五年随访时的足踝结局评分（FAOS）。此外，还比较了FAOS各亚量表的改善情况。使用标准负重X线片比较两组术前畸形、术后植入物对线、假体周围囊肿数量和下沉情况。
再次手术最常见的原因是沟撞击（n = 11），其次是内踝应力性骨折（n = 2）、跗管综合征（n = 1）、假体周围囊肿（n = 1）和感染（n = 1）。与未再次手术组相比，再次手术组在最终随访时除运动和娱乐活动亚量表外的所有FAOS亚量表均显著较低。再次手术组在最终随访时疼痛、症状和生活质量亚量表的改善明显较少（p < 0.05）。两组之间影像学参数无统计学差异。
TAA术后接受再次手术的患者在中期随访时功能结局较差。应着重预防再次手术的可能原因以获得良好的患者结局。此外，如果认为有必要进行再次手术，应全面评估并手术纠正潜在病因。
