Patient-related Risk Factors Associated with Poorer Outcomes Following Total Ankle Arthroplasty: A Scoping Review of 101552 Cases

Abstract

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty and ankle arthrodesis are both first line options for end stage arthritis. Both have good outcomes in terms of patient reported outcome measures, complications, and revision rate. Despite efforts to determine a superior option, results are inconsistent. It may be better to take a patient-specific approach in deciding which procedure to use based on risk factors such as BMI, age, and co-morbidities. This scoping review aims to identify and summarise all literature on total ankle arthroplasty and risk factors to guide a patient-specific decision making process, helping clinicians refine selection criteria and identify patients who are likely to respond well to the procedure. Methods: A scoping review was performed using the Preferred Reporting Items for Systematic Reviews an Meta-Analyses (PRISMA) guidelines. Computer based literature searching was performed in PubMed, Embase, Cochrane trials and ISI Web of science. Two reviewers independently performed title/abstract and full text screening according to pre-determined selection criteria. English-language original research studies reporting patient related factors associated with a poorer outcome following total ankle arthroplasty were included. Outcomes were defined as patient reported outcome measures (PROMs), peri-operative complications and failure. Results: A total of 94 studies reporting 101,552 cases of total ankle arthroplasty in 101,177 patients were included. The most common patient-related risk factor associated with poorer outcomes were younger age (21 studies), rheumatoid arthritis (17 studies) and diabetes (16 studies). Of the studies using multivariate regression specifically, the most frequently described risk factors were younger age (12 studies), rheumatoid arthritis (8 studies) and diabetes (8 studies). Conclusion: When controlling for cofounding factors, the most commonly reported risk factors are younger age, rheumatoid arthritis and co-morbidities such as diabetes and smoking. These patient-related risk factors reported may be used to facilitate the refinement of patient selection criteria for total ankle arthroplasty and inform patient expectations.