Total Ankle Replacement Outcome in Patients With Inflammatory Versus Noninflammatory Arthritis: A Systematic Review and Meta-analysis

Abstract

Background The decision regarding total ankle replacement (TAR) is challenging in patients with inflammatory arthritis (IA) regarding more inferior bone quality, large bone cysts, and increased risk of infections. This systematic review and meta-analysis aimed to compare the functional outcome, revision rate, complication rate, and survival rate of TAR between IA (including rheumatoid arthritis [RA]) and noninflammatory arthritis (NIA) (primary and posttraumatic). Methods After reviewing the full texts, 30 articles fulfilled all inclusion criteria from 1985 until 2021, comparing TAR results. The eligible studies included 5508 patients, of whom 1565 patients had IA and 3943 patients had NIA. At the time of surgery, the average age was 58 years in the IA group and 63 in the NIA group. The average follow-up was 67.2 months in the IA group and 67 months in the NIA group. The outcome measures were the American Orthopaedic Foot and Ankle Society (AOFAS) score and the rate of complications, revisions, and survival. Results The mean final AOFAS score was 82 (95% confidence interval [CI]: 78-86) in the IA group and 83 (95% CI: 78-88) in the NIA group, with no significant difference. There was no significant difference in the mean preoperative to postoperative AOFAS score change between the IA and the NIA. The complication rate was 16% (95% CI: 9%-27%) in the IA group and 15% (95% CI: 8%-27%) in the NIA group with no significant difference. The revision rate was 12% (95% CI: 10%-15%) in the IA group and 13% (95% CI: 10%-18%) in the NIA group, which was significant (P = .04). There was no significant difference in the survival rate between IA and NIA. Conclusion Total ankle replacement is a safe procedure in inflammatory ankle arthritis, specifically in RA patients with relatively minor and major complications close to other reasons for ankle replacement. Levels of Evidence: Level IV: prognostic

Chronic Steroid Use Does Not Increase the Risk of Superficial Surgical Site Infection or Wound Dehiscence Following Total Ankle Arthroplasty

“…Notably, Ling et al also did not find a significant correlation between chronic steroid use and superficial SSI or wound dehiscence [ 18 ]. Additionally, our findings are consistent with a recent meta-analysis and systematic review conducted by Mousavian et al, which demonstrated comparable complication rates between inflammatory and noninflammatory arthritis patients undergoing TAA [ 24 ]. This meta-analysis supports our conclusion that TAA is a safe and effective procedure in patients who may be taking chronic steroids for inflammatory arthritis.…”

A clinical practice guideline for the management of the foot and ankle in rheumatoid arthritis

“…Post-surgical iatrogenic effects have also been described, such as: ankylosis in the midfoot [ 59 ], increase in rearfoot varus, and increased forefoot stiffness, failed total ankle arthroplasty leading to arthrodesis of the ankle [ 60 ]. However, in a recent meta-analysis, it has been concluded that total ankle replacement is a safe procedure for RA patients with difficulties close to other reasons for ankle replacement [ 61 ] (Table 2 ).…”