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Archives of Orthopaedic and Trauma Surgery

Published in:

23-11-2023 | Incision | Orthopaedic Surgery

Staged vs concurrent hardware removal in total ankle arthroplasty

Authors: Antonio Mazzotti, Alberto Arceri, Simone O. Zielli, Simone Bonelli, Elena Artioli, Pejman Abdi, Cesare Faldini

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2024

Abstract

Introduction

Ankle osteoarthritis is more commonly posttraumatic. Consequently, dealing with hardware removal is quite frequent when performing a total ankle arthroplasty (TAA). The purpose of this study is to compare outcomes regarding either a staged or concurrent hardware removal when performing TAA.

Materials and methods

275 consecutive patients with TAA previously treated with internal fixation were retrospectively reviewed. Finally, 57 patients were enrolled based on exclusion criteria, and were differentiated into two groups considering the timing of hardware removal (staged—group A vs concurrent—group B) to compare: neurovascular and wound complications, time to recover full weight bearing, scar-tissue esthetic, and surgical time. Moreover, a subgroup comparison considering the surgical approach (single approach, minor additional approach, major additional approach) was performed between the group A and group B.

Results

No statistically significant difference other that longer surgical time (p < 0.05) was observed between group A and group B. When considering surgical approach subgroups, statistically significant higher surgical wound complications and revision rate were reported in group B (concurrent) major additional approach subgroup, and a statistically significant shorter time to full weight bearing was reported in group A (staged) major additional approach subgroup.

Conclusions

When performing TAA requiring hardware removal, no clear superiority of staged over concurrent hardware removal was observed. However, when considering a subgroup of patients requiring a separate major incision, a staged approach has shown reduced surgical time, less risk of wound complications, and shorter recovery to full weight bearing.

Level of evidence

III.

Shih C-L, Chen S-J, Huang P-J (2020) Clinical outcomes of total ankle arthroplasty versus ankle arthrodesis for the treatment of end-stage ankle arthritis in the last decade: a systematic review and meta-analysis. J Foot Ankle Surg 59:1032–1039. https://doi.org/10.1053/j.jfas.2019.10.008CrossRefPubMed

Saltzman CL, Salamon ML, Blanchard GM et al (2005) Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J 25:44–46PubMedPubMedCentral

Valderrabano V, Horisberger M, Russell I et al (2009) Etiology of ankle osteoarthritis. Clin Orthop Relat Res 467:1800–1806. https://doi.org/10.1007/s11999-008-0543-6CrossRefPubMed

Smith EJ, Katakam A, Box HN et al (2020) Staged vs concurrent hardware removal during conversion total knee arthroplasty. J Arthroplast 35:3569–3574. https://doi.org/10.1016/j.arth.2020.06.055CrossRef

Lizaur-Utrilla A, Collados-Maestre I, Miralles-Muñoz FA, Lopez-Prats FA (2015) Total knee arthroplasty for osteoarthritis secondary to fracture of the Tibial Plateau. A prospective matched cohort study. J Arthroplast. https://doi.org/10.1016/j.arth.2015.02.032CrossRef

Ge DH, Anoushiravani AA, Kester BS et al (2018) Preoperative diagnosis can predict conversion total knee arthroplasty outcomes. J Arthroplasty 33:124-129.e1. https://doi.org/10.1016/j.arth.2017.08.019CrossRefPubMed

Mazzotti A, Viglione V, Gerardi S et al (2022) Post-operative management after total ankle arthroplasty: a systematic review of the literature. Foot Ankle Surg 28:535–542. https://doi.org/10.1016/j.fas.2021.05.013CrossRefPubMed

Rosson J, Murphy W, Tonge C, Shearer J (1991) Healing of residual screw holes after plate removal. Injury 22:383–384. https://doi.org/10.1016/0020-1383(91)90100-SCrossRefPubMed

Mader K, Verheyen CC, Gausepohl T, Pennig D (2007) Minimally invasive ankle arthrodesis with a retrograde locking nail after failed fusion. Strateg Trauma Limb Reconstr 2:39–47. https://doi.org/10.1007/s11751-007-0018-4CrossRef

10.

Yu H, Wang F, Xie J et al (2022) The reinforced Ma-Griffith method combined with minimally invasive small-incision suture for acute Achilles tendon rupture. Orthop Surg 14:315–322. https://doi.org/10.1111/os.13140CrossRefPubMed

11.

ElTayeby HM (2012) Multiple tenotomies after Ponseti method for management of severe rigid clubfoot. J Foot Ankle Surg 51:156–160. https://doi.org/10.1053/j.jfas.2011.10.038CrossRefPubMed

12.

Tarabichi S, Chen AF, Higuera CA et al (2023) 2022 American Association of hip and knee surgeons symposium: periprosthetic joint infection. J Arthroplasty S0883–5403(23):00065–00067. https://doi.org/10.1016/j.arth.2023.01.045CrossRef

13.

Rusciani L, Robins P (2008) Textbook of dermatologic surgery. PICCIN. p. 183. ISBN 978-88-299-1898-0

14.

Mazzotti A, Geraci G, Panciera A et al (2019) Trends in surgical management of the infected total ankle arthroplasty. Eur Rev Med Pharmacol Sci 23:159–172. https://doi.org/10.26355/eurrev_201904_17486CrossRefPubMed

15.

Draaijers LJ, Tempelman FRH, Botman YAM et al (2004) The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113:1960–1965. https://doi.org/10.1097/01.prs.0000122207.28773.56. (discussion 1966-1967)CrossRefPubMed

16.

Hofmann KJ, Shabin ZM, Ferkel E et al (2016) Salto Talaris total ankle arthroplasty: clinical results at a mean of 5.2 years in 78 patients treated by a single surgeon. J Bone Jt Surg Am 98:2036–2046. https://doi.org/10.2106/JBJS.16.00090CrossRef

17.

Fram B, Corr DO, Rogero RG et al (2022) Short-term complications and outcomes of the Cadence total ankle arthroplasty. Foot Ankle Int 43:371–377. https://doi.org/10.1177/10711007211043853CrossRefPubMed

18.

Daniels TR, Mayich DJ, Penner MJ (2015) Intermediate to long-term outcomes of total ankle replacement with the Scandinavian total ankle replacement (STAR). J Bone Jt Surg Am 97:895–903. https://doi.org/10.2106/JBJS.N.01077CrossRef

19.

Oliver SM, Coetzee JC, Nilsson LJ et al (2016) Early patient satisfaction results on a modern generation fixed-bearing total ankle arthroplasty. Foot Ankle Int 37:938–943. https://doi.org/10.1177/1071100716648736CrossRefPubMed

20.

Hendy BA, McDonald EL, Nicholson K et al (2018) Improvement of outcomes during the first two years following total ankle arthroplasty. J Bone Jt Surg Am 100:1473–1481. https://doi.org/10.2106/JBJS.17.01021CrossRef

21.

Criswell B, Hunt K, Kim T et al (2016) Association of short-term complications with procedures through separate incisions during total ankle replacement. Foot Ankle Int 37:1060–1064. https://doi.org/10.1177/1071100716651964CrossRefPubMed

22.

Cheng H, Chen BP-H, Soleas IM et al (2017) Prolonged operative duration increases risk of surgical site infections: a systematic review. Surg Infect 18:722–735. https://doi.org/10.1089/sur.2017.089CrossRef

23.

Tucci G, Romanini E, Zanoli G et al (2019) Prevention of surgical site infections in orthopaedic surgery: a synthesis of current recommendations. Eur Rev Med Pharmacol Sci 23:224–239. https://doi.org/10.26355/eurrev_201904_17497CrossRefPubMed

24.

Li T, Zhang H, Chan PK et al (2022) Risk factors associated with surgical site infections following joint replacement surgery: a narrative review. Arthroplasty 4:11. https://doi.org/10.1186/s42836-022-00113-yCrossRefPubMedPubMedCentral

Title: Staged vs concurrent hardware removal in total ankle arthroplasty
Authors: Antonio Mazzotti
Alberto Arceri
Simone O. Zielli
Simone Bonelli
Elena Artioli
Pejman Abdi
Cesare Faldini
Publication date: 23-11-2023
Publisher: Springer Berlin Heidelberg
Keyword: Incision
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2024
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-05121-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Staged vs concurrent hardware removal in total ankle arthroplasty

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

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