Baylor University Medical Center, Dallas, TX, USA.
Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA.
Foot Ankle Int. 2023 Nov;44(11):1075-1084. doi: 10.1177/10711007231194050. Epub 2023 Sep 29.
Ankle arthritis that develops after fracture accounts for a significant portion of ankle arthritis necessitating total ankle arthroplasty (TAA). It remains unknown whether TAA in postfracture patients produces equivalent outcomes to those without fracture history. The purpose of this study was to evaluate the medium-term outcomes of TAA in postfracture ankle arthritis compared to those without fracture history.
This study reviewed 178 ankles from 171 consecutive patients who underwent TAA in our institution between 2007 and 2017 and completed a minimum 5-year follow-up. Four different TAA systems were utilized by 6 surgeons. Based on fracture history, patients were divided into 2 groups: the postfracture group (n = 63; median age 65.7 years; median follow-up 5.9 years) and the nonfracture group (n = 115; median age 64.4 years; median follow-up 6.2 years). Types and rates of complications including revision and reoperation were compared. Minimum 5-year Foot and Ankle Outcome Score (FAOS) and postoperative improvement were investigated. A subgroup analysis was performed to determine whether outcomes differ between intraarticular fracture patients (n = 43) and extraarticular fracture patients (n = 20).
Both groups exhibited comparable postoperative improvement and final FAOS scores. The postfracture group had a significantly higher reoperation rate than the nonfracture group (20 of 63, 31.7%, vs 17 of 115, 14.8%; = .011), with gutter impingement being the most common cause. There were 3 revisions in each group. In the subgroup analysis, we found no evidence of statistical difference between the intraarticular fracture group and the extraarticular fracture group in terms of FAOS scores, revision, and reoperation rates.
In this single-center, retrospective comparative study, we found total ankle arthroplasty in patients with a history of fractures around the ankle joint had no evidence of statistical difference in patient-reported outcomes and implant survivorship but led to a higher rate of nonrevision reoperation following surgery. In the much smaller subset of patients with previous fracture, we did not find that those with a history of intraarticular fracture had inferior outcomes after TAA when compared to those with a history of extraarticular fracture.
Level III, case-control study.
骨折后发生的踝关节关节炎占需要全踝关节置换术（TAA）的踝关节关节炎的很大一部分。目前尚不清楚骨折患者的 TAA 是否与无骨折病史的患者产生等效的结果。本研究旨在评估与无骨折病史患者相比，TAA 在骨折后踝关节关节炎中的中期结果。
本研究回顾了 2007 年至 2017 年间在我们机构接受 TAA 的 171 例连续患者的 178 例踝关节，所有患者均完成了至少 5 年的随访。6 位外科医生使用了 4 种不同的 TAA 系统。根据骨折史，患者分为两组：骨折组（n=63；中位年龄 65.7 岁；中位随访时间 5.9 年）和非骨折组（n=115；中位年龄 64.4 岁；中位随访时间 6.2 年）。比较了包括翻修和再次手术在内的并发症的类型和发生率。调查了最低 5 年足踝结局评分（FAOS）和术后改善情况。进行了亚组分析，以确定关节内骨折患者（n=43）和关节外骨折患者（n=20）之间的结果是否存在差异。
两组患者术后改善和最终 FAOS 评分均相当。骨折组的再次手术率明显高于非骨折组（20/63，31.7%，vs 17/115，14.8%；=0.011），其中最常见的原因是沟撞击。两组各有 3 例翻修。在亚组分析中，我们发现关节内骨折组和关节外骨折组在 FAOS 评分、翻修和再次手术率方面没有统计学差异的证据。
在这项单中心回顾性对照研究中，我们发现踝关节周围骨折患者的 TAA 在患者报告的结果和植入物存活率方面没有统计学差异，但手术后非翻修再次手术的发生率较高。在先前骨折的患者中，我们发现与关节外骨折相比，关节内骨折病史的患者在 TAA 后并没有出现结果更差的情况。
三级，病例对照研究。
