학술논문
Total Ankle Replacement Outcome in Patients With Inflammatory Versus Noninflammatory Arthritis: A Systematic Review and Meta-analysis.
Document Type
Academic Journal
Author
Mousavian A; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.; Baradaran A; Department of Family Medicine, McGill University, Montréal, QC, Canada.; Schon LC; Mercy Medical Center, Baltimore, Maryland.; New York University Grossman School of Medicine, New York, New York.; Johns Hopkins School of Medicine, Baltimore, Maryland.; Georgetown School of Medicine, Washington, DC.; Daniel J; Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.; Pedowitz D; Sidney Kimmel Medical College, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.; Kachooei AR; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.; Rothman Orthopaedics Florida at AdventHealth, Orlando, FL.
Source
Publisher: Sage Publications Country of Publication: United States NLM ID: 101473598 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1938-7636 (Electronic) Linking ISSN: 19386400 NLM ISO Abbreviation: Foot Ankle Spec Subsets: MEDLINE
Subject
Language
English
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.
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.