Background

Total ankle arthroplasty (TAA) is increasingly used as a treatment for end-stage ankle arthropathy. However, TAA may be more sensitive to complications, failure and subsequent re-operations compared to ankle arthrodesis. The aim of this systematic review and meta-analysis is to generate an overview of complications of TAA surgery.

Methods

PubMed, EMBASE and the Cochrane library were searched between 2000 and 2020 to identify all papers reporting on complications in TAA surgery. Meta-analysis was conducted based on type of complication in TAA surgery. Pooled estimates of complications were calculated using a random effects model. Risk of bias and quality was assessed using the Cochrane risk of bias and ROBINS-I tools. The confidence in estimates was rated and described according to the recommendations of the GRADE working group.

Results

One hundred twenty-seven studies were included in this systematic review. All combined, they reported on 16.964 TAAs with an average follow-up of 47.99 ± 29.18 months. Complications with highest reported pooled incidence were intra-operative fracture 0.06 (95 %CI 0.04–0.08) (GRADE Very low) and impingement 0.06 (95 %CI 0.04–0.08) (GRADE low) respectively.

Conclusion

Reported complication incidence of TAA surgery is still high and remains a significant clinical problem that can be severely hampering long-term clinical survival of the prosthesis. The results of this systematic review and meta-analysis can help guide surgeons in informing their patient about complication risks. Implementation of more stringent patient selection criteria might contribute to diminishing TAA complication rates.

中文翻译：

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全踝关节置换术后的并发症：系统的文献回顾和荟萃分析

背景

全踝关节置换术 (TAA) 越来越多地用于治疗终末期踝关节病。然而，与踝关节融合术相比，TAA 可能对并发症、失败和随后的再次手术更敏感。本系统回顾和荟萃分析的目的是对 TAA 手术的并发症进行概述。

方法

在 2000 年至 2020 年间搜索了 PubMed、EMBASE 和 Cochrane 图书馆，以确定所有报告 TAA 手术并发症的论文。根据 TAA 手术并发症的类型进行荟萃分析。使用随机效应模型计算并发症的合并估计值。使用 Cochrane 偏倚风险和 ROBINS-I 工具评估偏倚风险和质量。根据 GRADE 工作组的建议对估计的置信度进行评级和描述。

结果

该系统评价纳入了 127 项研究。总而言之，他们报告了 16.964 个 TAA，平均随访时间为 47.99 ± 29.18 个月。合并发生率最高的并发症分别为术中骨折 0.06 (95%CI 0.04–0.08)（极低级）和撞击 0.06（95%CI 0.04–0.08）（低级）。

结论

据报道，TAA 手术的并发症发生率仍然很高，并且仍然是一个重大的临床问题，可能严重阻碍假体的长期临床生存。该系统回顾和荟萃分析的结果可以帮助指导外科医生告知患者并发症风险。实施更严格的患者选择标准可能有助于降低 TAA 并发症发生率。