Primary vs. Revision Ankle Arthrodesis

Abstract

Category: Ankle Arthritis Introduction/Purpose: The current standard treatment for failed ankle arthrodesis is a revision ankle arthrodesis. However, there is limited literature addressing postoperative outcomes in patients with revision tibiotalar arthrodesis. The objectives of the retrospective study were to compare (1) demographics, (2) surgical technique, (3) postoperative fusion rates, and (4) postoperative complication rates in patients with primary vs. revision tibiotalar arthrodesis. Methods: Between March 2002 and November 2014, 455 ankle arthrodeses were performed in our institution. There were 234 male and 221 female patients with a mean age of 55.6 ± 15.1 years (18.0-88.8). The mean weight, height, and body mass index (BMI) were 90.3 ± 21.3 kg (46-218), 172.8 ± 13.6 cm (147-208), and 30.2 ± 6.3 kg/m2 (18.9-61.7), respectively. Both patient groups were compared with regard to demographics including gender, weight, height, BMI, ASA classification, smoking, alcohol use, and comorbidities. The surgical technique has been analyzed in both groups including surgical approach, main fixation type, allograft/autograft use, and use of bone morphogenic protein. Finally, fusion rate and time to complete osseous fusion were analyzed. Complication rates including wound complications, deep vein thrombosis/pulmonary embolism, and any secondary procedures were described in both groups. The mean time to final follow-up was 38.3 ± 27.4 months (12.0-150.4). Results: There were 385 and 70 patients with primary and revision arthrodesis, respectively. Demographics and comorbidities were comparable in both groups. All revision surgeries were open procedures, while 63 of 385 primary ankle arthrodeses were performed arthroscopically. The most common main fixation type in patients with primary ankle arthrodesis was a screw construct, while plates were most common for revisions (P < 0.001). The use of autograft was comparable in both groups (P = 0.886), however allograft was used more frequently in the revision arthrodesis group (P < 0.001). The rate of osseous union was comparable in both groups with 90.4% and 91.4% in patients with primary and revision arthrodesis, respectively (P = 0.735). The complication rate was comparable in both groups. Conclusion: The osseous union rates and complication rates were comparable in both patient groups, with primary and revision ankle arthrodesis.