Association of Short-term Complications With Procedures Through Separate Incisions During Total Ankle Replacement

Criswell, Braden; Hunt, Kenneth J.; Kim, Todd; Chou, Loretta B.; Haskell, Andrew

doi:10.1177/1071100716651964

Cited by 14 publications

(2 citation statements)

References 22 publications

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“…The early peak is expected to be for general mobilization and initiation of ankle motion, as some have advocated. 6 The subsequent bell-shaped distribution is interpreted as the implementation of further exercises that have been advocated for week 2, 3 , 5 , 20 week 4, 8 , 9 , 11 or week 6. 1 , 2 , 15 …”

Section: Discussionmentioning

confidence: 99%

Home and Outpatient Physical Therapy Utilization Following Total Ankle Replacement

Ratnasamy

Gouzoulis

Kammien

et al. 2022

Foot & Ankle Orthopaedics

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Background: Physical therapy (PT) following total ankle replacement (TAR) is often considered, but guidelines for its use are not standardized. Although patient factors may dictate recommendations, this retrospective cohort study aims to characterize baseline utilization practices to set the stage for establishing generalizable recommendations. Methods: TAR patients were identified from the 2010-2019 M91 Ortho PearlDiver data set based on administrative coding. Patient factors were extracted, including age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which patients’ surgery was performed (Midwest, Northeast, South, West), and insurance plan (commercial, Medicaid, Medicare). The incidence, timing, and frequency of home or outpatient PT utilization in the 90 days following TAR were identified. Inpatient PT was not captured. Univariate and multivariate logistic regression analyses allowed identification of predictive factors for PT utilization. Results: Of 5412 TAR patients identified, postoperative PT services were used by 2453 (45.3%). Most PT was outpatient (38.3% of the study population) compared to home (4.1% of the study population). Weekly utilization of PT was greatest in the first week following surgery (17.7% of PT visits) and thereafter followed a roughly bell-shaped curve, with utilization greatest at 7 weeks following surgery (14.9% of PT visits). Independent predictors of PT utilization following TAR included having surgery performed in the Midwest (relative to the South, OR 1.37, P < .0001), Northeast (OR 1.20, P = .0217), or West (OR 1.26, P < .0021) and having commercial (relative to Medicare, OR 1.87, P < .0001) or Medicaid insurance (OR 1.46, P = .0239). Conclusion: Of 5412 TAR patients, 42.5% used PT within 90 days of surgery. PT utilization was highest in the first and seventh weeks following surgery, and demographic predictors of PT use were defined. Through identification of timing and predictors of PT utilization following TAR, PT care pathways may be better defined. Level of Evidence: Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Home and Outpatient Physical Therapy Utilization Following Total Ankle Replacement

Ratnasamy

Gouzoulis

Kammien

et al. 2022

Foot & Ankle Orthopaedics

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“…Total ankle replacement through the anterior approach (TAR-AA) is an increasingly popular treatment for ankle arthritis. 20,31 This approach carries significant risk for wound complications, reported from 3%-40% in historical studies, [2][3][4]8,13,14,18,21,23,28 although the definition of "wound complication" is highly variable and inconsistently reported. 19 Although many of these wound complications are treated successfully without additional surgery, complications present an inconvenience to the patient and a burden on the health care system.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Soft Tissue Expansion Strips and Wound Complications After Total Ankle Arthroplasty

et al. 2022

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Background: Total ankle arthroplasty through the anterior approach (TAR-AA) is an increasingly popular treatment for ankle arthritis, but it carries a known risk for wound complications. Several products have been investigated to mitigate this risk; however, most are either costly or invasive. Noninvasive skin expansion strips (NSESs) were designed to transfer tension away from the incision and induce new skin growth at the edges of the strips. We hypothesize that postoperative application of NSESs will decrease unplanned clinic visits and wound complications after TAR-AA. Methods: This is a prospective cohort study of 41 patients at a single institution (3 surgeons) treated with NSESs after undergoing TAR-AA. An additional 41 consecutive historical patients treated without NSESs were retrospectively included as a control group. Patients received application of NSESs in the operating room after routine wound closure and again 2 weeks postoperatively. No other changes were made to the surgeons’ wound closure technique, immobilization, follow-up timing, or rehabilitation protocols. Primary outcomes included (1) additional clinic visit required for wound assessment or suture removal, (2) superficial wound complication, and (3) deep infection. Results: Baseline demographics did not differ significantly from our 41 consecutively treated historical controls. Additional clinic visits for suture removal or wound evaluation were significantly lower for patients treated with NSESs (15%, 6 of 41) compared to the control group (49%, 20 of 41) ( P = .001). There was also a significant difference in the superficial wound complication rate in the treatment group vs control group, 2% and 12%, respectively ( P = .04). There were no deep infections in either group. Conclusion: Noninvasive skin expansion strips placed after TAR-AA with an anterior approach have the potential to decrease wound complications and unplanned clinic visits. Further high-volume or randomized studies are needed to clarify their cost effectiveness and effect on long-term outcomes. Level of Evidence: Level II, prospective cohort study.

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Total Ankle Arthroplasty

Cook¹,

Cook²,

Basile³

et al. 2020

Evidence-Based Podiatry

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Association of Short-term Complications With Procedures Through Separate Incisions During Total Ankle Replacement

Abstract: Level III, comparative series.

Cited by 14 publications

References 22 publications

Home and Outpatient Physical Therapy Utilization Following Total Ankle Replacement

Home and Outpatient Physical Therapy Utilization Following Total Ankle Replacement

Noninvasive Soft Tissue Expansion Strips and Wound Complications After Total Ankle Arthroplasty

Total Ankle Arthroplasty

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