The outcomes of revision surgery for a failed ankle arthroplasty: a systematic review and meta-analysis
Aims: Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of liter...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2022-07-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.37.BJO-2022-0038.R1 |
| _version_ | 1828397249568178176 |
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| author | Toby Jennison Claire Spolton-Dean Hannah Rottenburg Obioha Ukoumunne Ian Sharpe Andrew Goldberg |
| author_facet | Toby Jennison Claire Spolton-Dean Hannah Rottenburg Obioha Ukoumunne Ian Sharpe Andrew Goldberg |
| author_sort | Toby Jennison |
| collection | DOAJ |
| description | Aims: Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations. Methods: A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed. Results: Six papers analyzed all-cause reoperations of revision ankle arthroplasties, and 14 papers analyzed failures of conversion of a TAA to fusion. It was found that 26.9% (95% confidence interval (CI) 15.4% to 40.1%) of revision ankle arthroplasties required further surgical intervention and 13.0% (95% CI 4.9% to 23.4%) of conversion to fusions; 14.4% (95% CI 8.4% to 21.4%) of revision ankle arthroplasties failed and 8% (95% CI 4% to 13%) of conversion to fusions failed. Conclusion: Revision of primary TAA can be an effective procedure with improved functional outcomes, but has considerable risks of failure and reoperation, especially in those with periprosthetic joint infection. In those who undergo conversion of TAA to fusion, there are high rates of nonunion. Further comparative studies are required to compare both operative techniques. Cite this article: Bone Jt Open 2022;3(7):596–606. |
| first_indexed | 2024-12-10T08:43:23Z |
| format | Article |
| id | doaj.art-f6ae5d34b1754b069a216741bdaee93a |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-12-10T08:43:23Z |
| publishDate | 2022-07-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-f6ae5d34b1754b069a216741bdaee93a2022-12-22T01:55:48ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622022-07-013759660610.1302/2633-1462.37.BJO-2022-0038.R1The outcomes of revision surgery for a failed ankle arthroplasty: a systematic review and meta-analysisToby Jennison0Claire Spolton-Dean1Hannah Rottenburg2Obioha Ukoumunne3Ian Sharpe4Andrew Goldberg5Royal Devon and Exeter NHS Foundation Trust, Exeter, UKRoyal Devon and Exeter NHS Foundation Trust, Exeter, UKUniversity of Exeter, Exeter, UKUniversity of Exeter, Exeter, UKRoyal Devon and Exeter NHS Foundation Trust, Exeter, UKWellington Hospital, London, UKAims: Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations. Methods: A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed. Results: Six papers analyzed all-cause reoperations of revision ankle arthroplasties, and 14 papers analyzed failures of conversion of a TAA to fusion. It was found that 26.9% (95% confidence interval (CI) 15.4% to 40.1%) of revision ankle arthroplasties required further surgical intervention and 13.0% (95% CI 4.9% to 23.4%) of conversion to fusions; 14.4% (95% CI 8.4% to 21.4%) of revision ankle arthroplasties failed and 8% (95% CI 4% to 13%) of conversion to fusions failed. Conclusion: Revision of primary TAA can be an effective procedure with improved functional outcomes, but has considerable risks of failure and reoperation, especially in those with periprosthetic joint infection. In those who undergo conversion of TAA to fusion, there are high rates of nonunion. Further comparative studies are required to compare both operative techniques. Cite this article: Bone Jt Open 2022;3(7):596–606.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.37.BJO-2022-0038.R1ankle replacementrevision ankle replacementankle arthrodesisankle arthroplastiesrevision surgeryrevision total ankle arthroplastytotal ankle arthroplasty (taa)periprosthetic joint infectionnonunionamputationsfunctional outcomesprimary total ankle arthroplastysurgical treatment |
| spellingShingle | Toby Jennison Claire Spolton-Dean Hannah Rottenburg Obioha Ukoumunne Ian Sharpe Andrew Goldberg The outcomes of revision surgery for a failed ankle arthroplasty: a systematic review and meta-analysis Bone & Joint Open ankle replacement revision ankle replacement ankle arthrodesis ankle arthroplasties revision surgery revision total ankle arthroplasty total ankle arthroplasty (taa) periprosthetic joint infection nonunion amputations functional outcomes primary total ankle arthroplasty surgical treatment |
| title | The outcomes of revision surgery for a failed ankle arthroplasty: a systematic review and meta-analysis |
| title_full | The outcomes of revision surgery for a failed ankle arthroplasty: a systematic review and meta-analysis |
| title_fullStr | The outcomes of revision surgery for a failed ankle arthroplasty: a systematic review and meta-analysis |
| title_full_unstemmed | The outcomes of revision surgery for a failed ankle arthroplasty: a systematic review and meta-analysis |
| title_short | The outcomes of revision surgery for a failed ankle arthroplasty: a systematic review and meta-analysis |
| title_sort | outcomes of revision surgery for a failed ankle arthroplasty a systematic review and meta analysis |
| topic | ankle replacement revision ankle replacement ankle arthrodesis ankle arthroplasties revision surgery revision total ankle arthroplasty total ankle arthroplasty (taa) periprosthetic joint infection nonunion amputations functional outcomes primary total ankle arthroplasty surgical treatment |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.37.BJO-2022-0038.R1 |
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