Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Duke University School of Medicine, Durham, North Carolina.
J Bone Joint Surg Am. 2024 Jan 3;106(1):10-20. doi: 10.2106/JBJS.23.00122. Epub 2023 Nov 3.
Although many patients with posttraumatic ankle arthritis are of a younger age, studies evaluating the impact of age on outcomes of primary total ankle arthroplasty (TAA) have revealed heterogenous results. The purpose of the present study was to determine the effect of age on complication rates and patient-reported outcomes after TAA.
We retrospectively reviewed the records of 1,115 patients who had undergone primary TAA. The patients were divided into 3 age cohorts: <55 years (n = 196), 55 to 70 years (n = 657), and >70 years (n = 262). Demographic characteristics, intraoperative variables, postoperative complications, and patient-reported outcome measures were compared among groups with use of univariable analyses. Competing-risk regression analysis with adjustment for patient and implant characteristics was performed to assess the risk of implant failure by age group. The mean duration of follow-up was 5.6 years.
Compared with the patients who were 55 to 70 years of age and >70 years of age, those who were <55 years of age had the highest rates of any reoperation (19.9%, 11.7%, and 6.5% for the <55, 55 to 70, and >70-year age groups, respectively; p < 0.001), implant failure (5.6%, 2.9%, and 1.1% for the <55, 55 to 70, and >70-year age groups, respectively; p = 0.019), and polyethylene exchange (7.7%, 4.3%, and 2.3% for the <55, 55 to 70, and >70-year age groups, respectively; p = 0.021). Competing-risk regression revealed a decreased risk of implant failure for patients who were >70 of age compared with those who were <55 years of age (hazard ratio [HR], 0.21 [95% confidence interval (CI), 0.05 to 0.80]; p = 0.023) and for patients who were 55 to 70 years of age compared with those who were <55 years of age (HR, 0.35 [95% CI, 0.16 to 0.77]; p = 0.009). For all subscales of the Foot and Ankle Outcome Score (FAOS) measure except activities of daily living, patients who were <55 years of age reported the lowest (worst) mean preoperative and postoperative scores compared with those who were 55 to 70 years of age and >70 years of age (p ≤ 0.001). Patients who were <55 years of age had the highest mean numerical pain score at the time of the latest follow-up (23.6, 14.4, 12.9 for the <55, 55 to 70, and >70-year age groups, respectively; p < 0.001).
Studies involving large sample sizes with intermediate to long-term follow-up are critical to reveal age-related impacts on outcomes after TAA. In the present study, which we believe to be the largest single-institution series to date evaluating the effect of age on outcomes after TAA, younger patients had higher rates of complications and implant failure and fared worse on patient-reported outcome measures.
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
尽管许多创伤后踝关节关节炎患者年龄较轻，但评估初次全踝关节置换术（TAA）后年龄对结果的影响的研究结果却存在差异。本研究旨在确定年龄对 TAA 后并发症发生率和患者报告结果的影响。
我们回顾性分析了 1115 例接受初次 TAA 的患者的病历。患者分为 3 个年龄组：<55 岁（n=196）、55~70 岁（n=657）和>70 岁（n=262）。使用单变量分析比较各组的人口统计学特征、术中变量、术后并发症和患者报告的结果测量指标。使用调整患者和植入物特征的竞争风险回归分析评估各年龄组的植入物失败风险。平均随访时间为 5.6 年。
与 5570 岁和>70 岁年龄组相比，<55 岁年龄组的任何再手术率（分别为 19.9%、11.7%和 6.5%；p<0.001）、植入物失败率（分别为 5.6%、2.9%和 1.1%；p=0.019）和聚乙烯置换率（分别为 7.7%、4.3%和 2.3%；p=0.021）最高。竞争风险回归显示，与<55 岁年龄组相比，>70 岁年龄组的植入物失败风险降低（风险比[HR]，0.21[95%置信区间（CI），0.050.80]；p=0.023），与 5570 岁年龄组相比，植入物失败风险也降低（HR，0.35[95%CI，0.160.77]；p=0.009）。除日常生活活动外，所有 FAOS 量表亚量表的术前和术后平均评分中，<55 岁年龄组报告的最低（最差）评分均低于 55~70 岁年龄组和>70 岁年龄组（p≤0.001）。<55 岁年龄组的末次随访时的平均数字疼痛评分最高（分别为 23.6、14.4、12.9；p<0.001）。
涉及大样本量和中至长期随访的研究对于揭示 TAA 后年龄相关结果的影响至关重要。在本研究中，我们认为这是迄今为止评估 TAA 后年龄对结果影响的最大单机构系列研究，年轻患者的并发症和植入物失败发生率更高，在患者报告的结果测量指标上表现更差。
预后 III 级。请参阅作者说明以获取完整的证据水平描述。
