Effect of Obesity on Total Ankle Arthroplasty: A Systematic Review of Postoperative Complications Requiring Surgical Revision

Sansosti, Laura E.; Van, Jennifer C.; Meyr, Andrew J.

doi:10.1053/j.jfas.2017.10.034

Cited by 29 publications

(16 citation statements)

References 51 publications

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“…This is on the upper end of the range of reported rates in the literature from 10% to 20%. 9,24 In our TAA registry, we have tried to be comprehensive in the reporting of complications, including all situations that could be associated with the placement of the TAA, such as Achilles contracture, persistent pain, and even some forefoot conditions. Other registries may fail to include some of these pathologies as complications potentially related to TAA, thus accounting for our slightly higher complication rate.…”

Section: Discussionmentioning

confidence: 99%

Total Ankle Arthroplasty: Does Obesity Matter?

et al. 2023

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Background: There is limited data evaluating the effect of obesity on outcomes following total ankle arthroplasty (TAA), especially in adequate sample sizes to detect impacts on patient-reported outcomes (PROs). The purpose of this study was to assess the effect of obesity on complication rates and PROs. Methods: This was a single-institution, retrospective study of 1093 primary TAA performed between 2001 and 2020. Minimum follow-up was 2 years. Patients were stratified by body mass index (BMI) into control (BMI = 18.5-29.9; n = 615), obesity class I (BMI = 30.0-34.9; n = 285), and obesity class II (BMI > 35.0; n = 193) groups. Patient information, intraoperative variables, postoperative complications, and PRO measures were compared between groups using univariable statistics. Multivariable Cox regression was performed to assess risk for implant failure. Mean follow-up was 5.6 years (SD: 3.1). Results: Compared to control and class I, class II patients had the lowest mean age ( P = .001), highest mean ASA score ( P < .001), and greatest proportion of female sex ( P < .001) and Black/African American race ( P = .005). There were no statistically significant differences in postoperative complications (infection, implant failure, or impingement) across the BMI classes ( P > .05). Preoperatively, class II had lower (worse) mean scores for Foot and Ankle Outcome Score pain and ADL subscales than controls (post hoc pairwise P < .001 for both). At final follow-up, both class II and class I had lower (worse) mean Short Musculoskeletal Function Assessment (post hoc pairwise P < .001 and P = .030, respectively) and 36-Item Short Form Health Survey scores (post hoc pairwise P < .001 and P = .005, respectively) than controls. Conclusion: At midterm follow-up, obesity was not associated with increased rates of complications after TAA. Patients with obesity reported worse musculoskeletal function and overall quality of life after TAA but there was no differential improvement in PROs across BMI classes. To our knowledge, this is the largest single-institution study to date examining the effect of obesity on outcomes after primary TAA. Level of Evidence: Level III, retrospective comparative study.

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Section: Discussionmentioning

confidence: 99%

Total Ankle Arthroplasty: Does Obesity Matter?

et al. 2023

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“…Similarly, obesity is also considered a risk factor in TAR for the development of complications requiring revisional surgery (≥17.8%) and may negatively influence the long-term outcomes. 45,48 The BMI was calculated for all patients according to the international formula weight in kilograms divided by height in meters squared (kg/m 2 ). 36 The cutoff for "obesity" is BMI = 30.…”

Section: Bmimentioning

confidence: 99%

Section: Scoring Criteriamentioning

confidence: 99%

Fast-Track for Total Ankle Replacement: A Novel Enhanced Recovery Protocol for Select Patients

Usuelli¹,

Paoli²,

Indino³

et al. 2022

Foot Ankle Int.

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Background: Enhanced recovery after surgery programs, also called fast-track protocols, were developed and successfully applied in the last decade for hip and knee reconstruction. Specific fast-track protocols have not yet been applied to ankle prostheses. The aim of the study was to develop and validate an enhanced recovery protocol for total ankle replacement (TAR) evaluating the clinical and radiographic results. We hypothesize that on the basis of well-defined pre- and postoperative characteristics, the current knowledge on ankle replacement, and referring to hip and knee reconstruction, it is possible to identify a "patient type" to be safely eligible to a Fast-Track Protocol with at least comparable results and without increasing the complications risk. Methods: We identified 8 predictive variables that might affect the outcome of TAR. Those variables were the body mass index, the state of anxiety or depression, the functional preoperative status, ankle equinus, the coronal malalignment, the surgical time, the surgical accessory procedures, and the bone quality. These characteristics were evaluated for each patient with almost validated outcome tools attributing a specific score. Based on the score obtained, the patients were divided into 2 groups: the Standard Protocol group (Control Group) and the Fast-Track Protocol group (Study Group). The main difference between treatment of the 2 groups relates to the use of postoperative plaster casts: in the Fast-Track group the cast was removed the first day after surgery and walking was allowed in sports shoes assisted with crutches, whereas in the Standard Protocol group, the cast was removed after 3 weeks. Clinical and radiographic evaluation was performed for all patients preoperatively and postoperatively every 6 months. Results: A total of 163 patients received a score between 1 and 5 and were included in the control group (Standard Protocol); 47 patients received a score of 0 and were allocated to the study group (Fast-Track Protocol). Clinically, except for the preoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score, no statistically significant differences were recorded in the multiple comparisons between the 2 groups. No significant differences were found regarding complications. Conclusion: In selected patients, it is possible to apply an enhanced recovery protocol of rehabilitation, focused on immediate weightbearing and mobilization without any plaster or boot. Level of Evidence: Level II, prospective comparative study.

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“…6,12 They include implant design, surgical skills, and patients factor including obesity or ages, and so on. 10,26…”

Section: Introductionmentioning

confidence: 99%

“…6,12 They include implant design, surgical skills, and patients factor including obesity or ages, and so on. 10,26 However, aseptic loosening and periprosthetic osteolysis in TAR is largely neglected in the previous literatures compared to those in total knee arthroplasty or total hip arthroplasty. 32 Osteolysis around implant is difficult to detect and quantitate in simple radiographs because osteolysis usually occurs in radiolucent cancellous bone and is hidden in the metallic component.…”

Section: Introductionmentioning

confidence: 99%

Does Perioperative Use of Bisphosphonate Affect the Implant Revision Rate of Total Ankle Arthroplasty?

Lee¹,

Jeon

Park³

et al. 2023

Foot Ankle Int.

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Background: It is unknown whether perioperative bisphosphonate (BP) use reduces revision rates in total ankle replacement arthroplasty (TAR) although its effect has been demonstrated to be effective in reducing revision rates in total knee or hip replacement arthroplasty. Methods: We reviewed National Health Insurance Service data based on national health insurance service claims data and health care utilization, health screening, sociodemographic variables, medication history, operation codes, and mortality data for 50 million Koreans. From 2002 to 2014, 6391 of 7300 patients who underwent TAR were BP nonusers, whereas 909 patients were BP users. The revision rate according to BP medication and comorbidities was investigated. The Kaplan-Meier estimate and extended Cox proportional hazard model were also used. Results: The revision rate of TAR was 7.9% for BP users and 9.5% for BP nonusers, which showed no significant difference ( P = .251). Implant survival over time decreased constantly. Adjusted hazard ratio for hypertension was 1.242 ( P = .017), whereas other comorbidities such as diabetes had no effect on the revision rate of TAR. Conclusion: We found that the perioperative BP use do not reduce the revision rate of TAR. Comorbidities except hypertension did not affect the revision rate of TAR. More research regarding various factors affecting the revision of TAR could be warranted. Level of Evidence: Level III, retrospective cohort study.

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Effect of Obesity on Total Ankle Arthroplasty: A Systematic Review of Postoperative Complications Requiring Surgical Revision

Cited by 29 publications

References 51 publications

Total Ankle Arthroplasty: Does Obesity Matter?

Total Ankle Arthroplasty: Does Obesity Matter?

Fast-Track for Total Ankle Replacement: A Novel Enhanced Recovery Protocol for Select Patients

Does Perioperative Use of Bisphosphonate Affect the Implant Revision Rate of Total Ankle Arthroplasty?

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