CHICAGO — Early results of lateral total ankle replacement compared with anterior total ankle replacement showed patients who underwent the lateral approach had a greater risk of deep infection requiring reoperation and inferior SF-36 scores 1 year after surgery. However, there were no significant differences between the groups regarding ankle osteoarthritis and ankle arthritis scores.
“The patient-reported outcomes are statistically not different at the baseline, 6 months and 1 year,” Oliver Gagné, MD, said during his presentation at the American Orthopaedic Foot & Ankle Society Annual Meeting. “We definitely need a larger sample size to get more power. We need to stratify patients as far as their severity in the [Canadian Orthopaedic Foot and Ankle Society] COFAS stage, as well as their adjunct procedure within the total ankle [replacement].”
In a prospective pilot study, Gagne and colleagues identified 64 total ankle replacements. Investigators documented patient demographics, baseline scores and postoperative measures including the ankle osteoarthritis score, the ankle arthritis score and the SF-36 score. They reported and coded any reoperations in a local database. The surgical approach was determined by the surgeon. There were 27 anterior total ankle replacements and 37 lateral total ankle replacements. Investigators noted patients who underwent lateral total ankle replacements had a higher stage of COFAS-type arthritis, longer intraoperative times and adjunct procedures.
Results showed patients who underwent total ankle replacement compared with those who had lateral total ankle replacement had superior SF-36 physical and mental component scores at 1 year. Investigators noted this was statistically significant and greater than the minimal clinically important difference. However, the two groups had similar ankle osteoarthritis scores and ankle arthritis scores postoperatively.
There were eight patients who had a reoperation, of which seven patients underwent a lateral approach and one patient underwent an anterior approach. Among patients who underwent the lateral approach, there were three surgical debridements for deep infection and wound complications, two ankle gutter/ heterotopic ossification (HO) debridements and two lateral hardware removals. In patients who underwent the anterior approach, there was one ankle gutter/HO debridement. – by Monica Jaramillo
Gagné O, et al. Lateral vs. anterior: A prospective cohort pilot study of PROs and reoperation rates. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 12-15, 2019; Chicago.
Disclosure: Gagné reports no relevant financial disclosures.