Post-operative management after total ankle arthroplasty: A systematic review of the literature

Mazzotti, Antonio; Viglione, Valentina; Gerardi, Simone; Bonelli, Simone; Zielli, Simone Ottavio; Geraci, Giuseppe; Faldini, Cesare

doi:10.1016/j.fas.2021.05.013

Cited by 10 publications

(3 citation statements)

References 95 publications

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“…To that end, the present study found that following TAR, 45.5% received physical therapy, highlighting the previously reported lack of consistency in postoperative rehabilitation. 14 Of those who received postoperative PT, the greatest use was in the first week, and then there was a bell-shaped distribution of visits from weeks 2 to 13, peaking at week 7. The early peak is expected to be for general mobilization and initiation of ankle motion, as some have advocated.…”

Section: Discussionmentioning

confidence: 93%

“…To that end, the present study found that following TAR, 45.5% received physical therapy, highlighting the previously reported lack of consistency in postoperative rehabilitation. 14 …”

Section: Discussionmentioning

confidence: 99%

“…Despite the importance of PT following TAR, guidelines for its use are discordant, with no current consensus on postoperative rehabilitation protocols currently existing. 14 , 18 No major orthopaedic surgery society currently provides detailed recommendations for PT utilization following TAR. Different health systems and orthopaedic practices recommend varied physical therapy protocols for TAR patients.…”

Section: Introductionmentioning

confidence: 99%

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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: 93%

“…To that end, the present study found that following TAR, 45.5% received physical therapy, highlighting the previously reported lack of consistency in postoperative rehabilitation. 14 …”

Section: Discussionmentioning

confidence: 99%