Department of Trauma and Orthopaedics, King's College Hospital NHS Foundation Trust, London, UK.
Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Surgeon. 2024 Jun;22(3):174-181. doi: 10.1016/j.surge.2024.01.004. Epub 2024 Feb 14.
This study evaluates the clinical outcomes of contemporary total ankle arthroplasty (TAAs) to primarily establish the current benefits and risks to facilitate informed decision making to secondarily establish if improvements are seen between subsequent generations of implants, bearing philosophy, and associated surgical technique.
A systematic review and meta-analysis of published data from January 2000 to January 2020 was conducted following PRISMA guidelines.
English language papers, adult population, ≥20 ankles with a minimum follow up ≥24 months, pre- and post-operative functional scores available. Ankle implants were characterised by generations, which were determined from the original studies and confirmed based on literature set definitions.
A total of 4642 TAAs in 4487 patients from 51 studies were included. The mean age was 61.9-years and follow up 57.8-months. Overall, 10-year survivorship rates were 77.63 %, with mobile bearing designs showing a small but significant advantage. Improved survivorship favoured the most modern implants at both two (p < 0.05), and 10-years (p < 0.01). The relative risk of a complication occurring improved with the evolution of implants e.g., nerve injury, and post-operative complications such as fracture, wound complications (e.g., dehiscence or heamatoma) and radiological abnormalities (e.g., radiolucencies, heterotopic bone formation and aseptic loosening). However, surgical site infection, and intra-operative fracture rates remain implant independent.
Modern TAA offers improved survivorship, even with a trend to lower mean implantation age, similar complexity and ever changing indications. It would appear that implant evolution has reduced risks, especially those associated with revision, without affecting functional outcomes.
本研究评估了当代全踝关节置换术（TAA）的临床结果，主要是为了确定当前的获益和风险，以便做出明智的决策，并进一步确定在随后的植入物、轴承理念和相关手术技术的几代人中是否看到了改善。
按照 PRISMA 指南，对 2000 年 1 月至 2020 年 1 月期间发表的文献进行了系统的回顾和荟萃分析。
英语文献，成人人群，至少 20 例踝关节，随访时间≥24 个月，术前和术后功能评分可用。踝关节植入物的特征是通过几代人来确定的，这是根据原始研究确定的，并根据文献集的定义进行了确认。
共有 51 项研究中的 4487 例患者的 4642 例 TAA 被纳入。平均年龄为 61.9 岁，随访时间为 57.8 个月。总的来说，10 年生存率为 77.63%，其中活动衬垫设计有一个小但显著的优势。最新型植入物的生存率更高，无论是在两年（p<0.05）还是 10 年（p<0.01）。随着植入物的发展，并发症发生的相对风险也有所改善，例如神经损伤和术后并发症，如骨折、伤口并发症（如裂开或血肿）和放射学异常（如透亮线、异位骨形成和无菌性松动）。然而，手术部位感染和术中骨折率仍然与植入物无关。
现代 TAA 提供了更好的生存率，即使存在平均植入年龄降低、复杂性相似和不断变化的适应证的趋势。似乎植入物的进化降低了风险，尤其是与翻修相关的风险，而不影响功能结果。
