Giambelluca Lacey, Umbel Benjamin, Anastasio Albert, Kim Billy, DeOrio James, Easley Mark, Nunley James A
Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
Duke University, Durham, NC, USA.
Foot Ankle Int. 2024 Apr;45(4):357-363. doi: 10.1177/10711007231221995. Epub 2024 Jan 28.
Ankle arthritis differs from arthritis of the hip and knee in that 80% is posttraumatic and thus often occurs in a younger patient population. The literature supporting total ankle arthroplasty (TAA) in younger patients has increased over recent years and has bolstered the argument that in the short term, TAA in younger patients has successful outcomes that are comparable to older, lower-demand patients.The purpose of our study was to evaluate patient-reported outcomes (PROs) and implant survivorship at midterm after primary TAA in patients ≤ 50 years of age at the time of surgery.
A retrospective chart review was conducted of patients ≤ 50 years of age who underwent primary TAA at a single institution from 2000 to 2017. Patient demographics, outcome measures, and complications were recorded. All patients had a minimum clinical follow-up of 5 years. PRO measures were evaluated at preoperative, 1-year postoperative, and final follow-up visits. Paired tests were performed to compare individual patient changes in PROs from preoperative. Implant survivorship was evaluated based on need for revision of either the tibial or talar component. The need for additional surgery related to the TAA was also evaluated.
A total of 58 patients were included. The average age at the time of the index surgery was 43.3 years (range 22-50 years). All patients had a minimum follow-up of 5 years with a mean follow-up of 8.8 years. A total of 11 patients required additional surgery related to their TAA. Six patients (10.3%) required bone grafting of peri-implant cysts, 3 patients (5.2 %) required gutter debridement, and 1 patient underwent complete revision of metal components. Mean visual analog scale, 36-item Short Form Health Survey, Short Musculoskeletal Function Assessment, and American Orthopaedic Foot & Ankle Society hindfoot scores significantly improved from preoperative to 1-year postoperative and final postoperative follow-up.
The patients aged ≤50 years treated with a TAA whom we have been able to observe for a minimum of 5 years showed generally maintained improvement in functional scores and thus far have had a relatively low rate of secondary surgeries.Level of Evidence:Level III, retrospective cohort study.
踝关节关节炎与髋、膝关节关节炎不同，80% 为创伤后关节炎，因此常发生于较年轻的患者群体。近年来，支持在年轻患者中进行全踝关节置换术（TAA）的文献有所增加，这进一步证明，短期内，年轻患者的 TAA 手术效果与年龄较大、需求较低的患者相当。本研究的目的是评估手术时年龄≤50 岁的患者在初次 TAA 术后中期的患者报告结局（PROs）和植入物生存率。
对 2000 年至 2017 年在单一机构接受初次 TAA 的年龄≤50 岁的患者进行回顾性病历审查。记录患者的人口统计学资料、结局指标和并发症。所有患者的临床随访时间均至少为 5 年。在术前、术后 1 年和最终随访时评估 PRO 指标。进行配对检验以比较个体患者术前术后 PROs 的变化。根据胫骨或距骨组件的翻修需求评估植入物生存率。还评估了与 TAA 相关的额外手术需求。
共纳入 58 例患者。初次手术时的平均年龄为 43.3 岁（范围 22 - 50 岁）。所有患者的随访时间均至少为 5 年，平均随访时间为 8.8 年。共有 11 例患者需要进行与 TAA 相关的额外手术。6 例患者（10.3%）需要对植入物周围囊肿进行植骨，3 例患者（5.2%）需要进行沟清创术，1 例患者接受了金属组件的完全翻修。从术前到术后 1 年以及最终术后随访，平均视觉模拟量表、36 项简明健康调查、简短肌肉骨骼功能评估和美国矫形足踝协会后足评分均显著改善。
我们能够观察至少 5 年的接受 TAA 治疗的年龄≤50 岁的患者，其功能评分总体保持改善，且迄今为止二次手术率相对较低。证据水平：III 级，回顾性队列研究。
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