1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, Italy.
Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123, Bologna, Italy.
Arch Orthop Trauma Surg. 2024 Feb;144(2):627-634. doi: 10.1007/s00402-023-05121-4. Epub 2023 Nov 23.
Ankle osteoarthritis is more commonly posttraumatic. Consequently, dealing with hardware removal is quite frequent when performing a total ankle arthroplasty (TAA). The purpose of this study is to compare outcomes regarding either a staged or concurrent hardware removal when performing TAA.
275 consecutive patients with TAA previously treated with internal fixation were retrospectively reviewed. Finally, 57 patients were enrolled based on exclusion criteria, and were differentiated into two groups considering the timing of hardware removal (staged-group A vs concurrent-group B) to compare: neurovascular and wound complications, time to recover full weight bearing, scar-tissue esthetic, and surgical time. Moreover, a subgroup comparison considering the surgical approach (single approach, minor additional approach, major additional approach) was performed between the group A and group B.
No statistically significant difference other that longer surgical time (p < 0.05) was observed between group A and group B. When considering surgical approach subgroups, statistically significant higher surgical wound complications and revision rate were reported in group B (concurrent) major additional approach subgroup, and a statistically significant shorter time to full weight bearing was reported in group A (staged) major additional approach subgroup.
When performing TAA requiring hardware removal, no clear superiority of staged over concurrent hardware removal was observed. However, when considering a subgroup of patients requiring a separate major incision, a staged approach has shown reduced surgical time, less risk of wound complications, and shorter recovery to full weight bearing.
III.
踝关节骨关节炎多为创伤后。因此，在进行全踝关节置换术（TAA）时，经常需要处理内固定去除。本研究旨在比较分期或同期行 TAA 时去除内固定的疗效。
回顾性分析 275 例接受内固定治疗的 TAA 连续患者。最终，根据排除标准纳入 57 例患者，并根据内固定去除时机（分期组 A 与同期组 B）将其分为两组进行比较：神经血管和伤口并发症、完全负重恢复时间、瘢痕组织美观度和手术时间。此外，还对 A 组和 B 组的手术入路（单入路、小附加入路、大附加入路）进行了亚组比较。
除手术时间较长外（p<0.05），A 组和 B 组之间无统计学差异。在考虑手术入路亚组时，B 组（同期）大附加入路亚组的手术伤口并发症和翻修率明显更高，A 组（分期）大附加入路亚组的完全负重恢复时间明显更短。
在需要去除内固定的 TAA 手术中，分期与同期去除内固定无明显优势。然而，当考虑需要单独大切口的患者亚组时，分期方法具有手术时间更短、伤口并发症风险更小和完全负重恢复更快的优点。
III 级。
