Ratnasamy Philip P, Maloy Gwyneth C, Oghenesume Oghenewoma P, Peden Sean C, Grauer Jonathan N, Oh Irvin
Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA.
Foot Ankle Orthop. 2023 Sep 25;8(3):24730114231198234. doi: 10.1177/24730114231198234. eCollection 2023 Jul.
Total ankle replacement (TAR) surgery has increased in recent decades. The aim of this study was to investigate the evolving burden of revision surgery and risk factors and timing of revision or explant.
Using the 2010 to 2020 PearlDiver M151Ortho data set, this retrospective cohort study identified primary TAR, TAR revision, and TAR explant patients via () and () codes. This database contains billing claims information across all payers and sites of care in the United States. Patient factors investigated included age, sex, and Elixhauser Comorbidity Index (ECI). Annual incidence for primary TAR was normalized per 100 000 covered lives in the data set for each year of study and recorded. Annual incidence of revision TAR and explant were normalized per 100 TARs performed for each year of study. Multivariate logistic regression analyses were performed to determine independent risk factors for revision TAR or explant. For explants, the eventual intervention by 2 years was analyzed. Ten-year timing and survival to revision or explant surgery following unilateral TAR were characterized.
A total of 10 531 primary, 1218 revision, and 1735 explant TARs were identified. After normalization, TAR utilization increased by 284% from 2010 to 2020, annual TAR revisions rose 28%, and annual TAR explants decreased 65%. Independent predictors of revision TAR were younger age (odds ratio [OR] 1.29 per decade decrease) and higher ECI (OR 1.23 per 2-point increase). Independent predictors of explant included younger age (OR 1.80 per decade decrease), female sex (OR 1.17), and higher ECI (OR 1.35 per 2-point increase). The 10-year implant survival rate was 91.8%, of which 73% of revisions and 83% of explants occurred in the first 3 years following index TAR.
TAR utilization has grown substantially over the past decade, with minimal increases in the annual rate of revision surgery with respect to index procedures performed.
Level III, retrospective cohort study.
近几十年来，全踝关节置换术（TAR）的手术量有所增加。本研究的目的是调查翻修手术负担的演变、危险因素以及翻修或取出植入物的时机。
利用2010年至2020年PearlDiver M151Ortho数据集，这项回顾性队列研究通过（）和（）编码识别初次TAR、TAR翻修和TAR取出植入物的患者。该数据库包含美国所有支付方和医疗机构的计费索赔信息。调查的患者因素包括年龄、性别和埃利克斯豪泽合并症指数（ECI）。在研究的每一年中，将初次TAR的年发病率按照数据集中每10万参保人数进行标准化并记录。在研究的每一年中，将TAR翻修和取出植入物的年发病率按照每100例TAR手术进行标准化。进行多因素逻辑回归分析以确定TAR翻修或取出植入物的独立危险因素。对于取出植入物的情况，分析了2年内的最终干预措施。对单侧TAR术后翻修或取出植入物手术的10年时机和生存率进行了描述。
共识别出10531例初次、1218例翻修和1735例取出植入物的TAR手术。标准化后，2010年至2020年TAR的使用率增长了284%，TAR年翻修率上升了28%，TAR年取出植入物率下降了65%。TAR翻修的独立预测因素为年龄较小（每降低一个十年，优势比[OR]为1.29）和ECI较高（每增加2分，OR为1.23）。取出植入物的独立预测因素包括年龄较小（每降低一个十年，OR为1.80）、女性（OR为1.17）和ECI较高（每增加2分，OR为1.35）。10年植入物生存率为91.8%，其中73%的翻修手术和83%的取出植入物手术发生在初次TAR后的前3年。
在过去十年中，TAR的使用率大幅增长，相对于初次手术，翻修手术的年增长率极小。
III级，回顾性队列研究。
