Background

Despite a significant reported rate of non-revision reoperation after total ankle arthroplasty (TAA), it is uncertain if these subsequent procedures have an impact on the longer term outcomes. This study aimed to compare minimum five-year functional outcomes of patients who had undergone reoperation after TAA to those who did not require reoperation.

Methods

Seventy-six ankles (74 patients) who underwent TAA with the Salto Talaris fixed bearing system between 2007 and 2014 were allocated into two groups based on presence (n = 16) or absence of reoperation (n = 60). Reoperations included all secondary procedures after index TAA, excluding revision surgeries requiring removal or exchange of the original prosthesis. The foot and ankle outcome score (FAOS) at preoperative and minimum five-year follow-up was compared between the groups. Additionally, improvements in FAOS subscales were compared. Preoperative deformity, postoperative implant alignment, number of periprosthetic cysts, and subsidence between groups were compared using standard weightbearing radiographs.

Results

The most common cause of reoperation was gutter impingement (n = 11), followed by stress fracture of the medial malleolus (n = 2), tarsal tunnel syndrome (n = 1), periprosthetic cyst (n = 1), and infection (n = 1). In comparison to the non-reoperation group, all FAOS subscales except for the Sports and Recreational Activities subscale were significantly lower in the reoperation group at final follow-up. The reoperation group exhibited significantly less improvement in the Pain, Symptoms, and Quality of Life subscales at final follow-up (p < 0.05). There were no statistical differences in the radiographic parameters between both groups.

Conclusions

Patients who underwent reoperation after TAA demonstrated inferior functional outcomes at mid-term follow-up. An emphasis should be placed on preventing possible causes of reoperations to achieve favorable patient outcomes. Additionally, if a reoperation is deemed necessary, a thorough evaluation and surgical correction of underlying causes should be achieved.

中文翻译：

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全踝关节置换术后再次手术后的中期功能结局：一项回顾性队列研究

背景

尽管全踝关节置换术 (TAA) 后非翻修再手术的报告率很高，但尚不确定这些后续手术是否会对长期结果产生影响。本研究旨在比较 TAA 后接受再次手术的患者与不需要再次手术的患者的至少五年功能结果。

方法

在 2007 年至 2014 年间使用 Salto Talaris 固定轴承系统接受 TAA 的 76 例脚踝（74 名患者）根据是否再次手术（n = 16）或未再次手术（n = 60）被分配到两组。再手术包括指数 TAA 后的所有二次手术，不包括需要移除或更换原始假体的翻修手术。比较各组在术前和至少 5 年随访时的足踝结局评分 (FAOS)。此外，还比较了粮农组织子尺度的改进。使用标准负重 X 光片比较术前畸形、术后种植体排列、假体周围囊肿数量和下沉情况。

结果

再次手术的最常见原因是下沟撞击 (n = 11)，其次是内踝应力性骨折(n = 2)、跗管综合征 (n = 1)、假体周围囊肿 (n = 1) 和感染 (n = 1). 与非再次手术组相比，在最终随访时，再次手术组除体育和娱乐活动分量表外的所有 FAOS 分量表均显着降低。在最后一次随访时，再次手术组在疼痛、症状和生活质量子量表方面的改善明显较小 (p < 0.05)。两组放射学参数无统计学差异。

结论

在 TAA 后接受再次手术的患者在中期随访时表现出较差的功能结果。应强调预防再次手术的可能原因，以实现良好的患者预后。此外，如果认为有必要再次手术，则应对根本原因进行彻底评估和手术矫正。