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Clinical Outcomes and Complications of Simultaneous or Sequential Bilateral Total Ankle Arthroplasty: A Single-Center Comparative Cohort Study.

Publication ,  Journal Article
Fletcher, AN; Johnson, LG; Easley, ME; Nunley, JA; DeOrio, JK
Published in: J Bone Joint Surg Am
October 5, 2022

BACKGROUND: The risk-benefit profiles of simultaneous total ankle arthroplasty (TAA) compared with sequential TAA continue to be debated. There are limited case series reporting outcomes after bilateral TAA, with no previous comparison of simultaneous TAA with sequential TAA. Patients with bilateral pathology represent a unique population with an overall more debilitating condition. Thus, we aimed to compare bilateral simultaneous and sequential TAAs, including perioperative complications and patient-reported outcome measures. METHODS: We performed a comparative cohort study of patients who underwent primary bilateral TAA, performed in a simultaneous or sequential fashion, from 2007 to 2019 at a single academic center. Data on patient demographic characteristics, comorbidities, perioperative complications, reoperations, and implant failures were collected. Patient-reported outcome measures included preoperative and postoperative visual analog scale (VAS) scores for pain, Short Form-36 Health Survey (SF-36) scores, and Short Musculoskeletal Function Assessment (SMFA) scores. RESULTS: A total of 50 patients (100 ankles) were included, with 25 patients (50 ankles) each in the bilateral simultaneous and sequential cohorts. The mean follow-up was 52.2 ± 27.3 months (range, 24 to 109 months). The mean time between sequential TAAs was 17.5 ± 20.1 months (range, 3 to 74 months). The mean patient age was 64.3 ± 10.6 years (range, 21 to 76 years), and 32 (64.0%) were men. The majority of patients (28 patients [56.0%]) had primary osteoarthritis. Both cohorts had equivalent preoperative patient-reported outcome measures and experienced improvements in all measures, which were maintained at the final follow-up with no significant between-group differences (all p > 0.05). There were no differences between the simultaneous TAA group and the sequential TAA group in perioperative complication rates (22.0% compared with 24.0%; p = 0.7788), reoperations (12.0% compared with 10.0%; p = 0.7354), 5-year reoperation-free survival (88.0% compared with 90.0%; p = 0.4612), or failure-free survival (100%). One patient in the simultaneous TAA cohort required metal component revision at 8 years postoperatively. CONCLUSIONS: The patient-reported outcome measures, complications, and prosthesis survival of patients who underwent bilateral simultaneous TAA were comparable with those of patients who underwent bilateral sequential TAA. We advocate that simultaneous bilateral TAA is a safe and effective method for the treatment of bilateral end-stage ankle osteoarthritis. LEVEL OF EVIDENCE: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

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Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

October 5, 2022

Volume

104

Issue

19

Start / End Page

1712 / 1721

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Retrospective Studies
  • Osteoarthritis
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cohort Studies
 

Citation

APA
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ICMJE
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Fletcher, A. N., Johnson, L. G., Easley, M. E., Nunley, J. A., & DeOrio, J. K. (2022). Clinical Outcomes and Complications of Simultaneous or Sequential Bilateral Total Ankle Arthroplasty: A Single-Center Comparative Cohort Study. J Bone Joint Surg Am, 104(19), 1712–1721. https://doi.org/10.2106/JBJS.22.00072
Fletcher, Amanda N., Lindsey G. Johnson, Mark E. Easley, James A. Nunley, and James K. DeOrio. “Clinical Outcomes and Complications of Simultaneous or Sequential Bilateral Total Ankle Arthroplasty: A Single-Center Comparative Cohort Study.J Bone Joint Surg Am 104, no. 19 (October 5, 2022): 1712–21. https://doi.org/10.2106/JBJS.22.00072.
Fletcher AN, Johnson LG, Easley ME, Nunley JA, DeOrio JK. Clinical Outcomes and Complications of Simultaneous or Sequential Bilateral Total Ankle Arthroplasty: A Single-Center Comparative Cohort Study. J Bone Joint Surg Am. 2022 Oct 5;104(19):1712–21.
Fletcher, Amanda N., et al. “Clinical Outcomes and Complications of Simultaneous or Sequential Bilateral Total Ankle Arthroplasty: A Single-Center Comparative Cohort Study.J Bone Joint Surg Am, vol. 104, no. 19, Oct. 2022, pp. 1712–21. Pubmed, doi:10.2106/JBJS.22.00072.
Fletcher AN, Johnson LG, Easley ME, Nunley JA, DeOrio JK. Clinical Outcomes and Complications of Simultaneous or Sequential Bilateral Total Ankle Arthroplasty: A Single-Center Comparative Cohort Study. J Bone Joint Surg Am. 2022 Oct 5;104(19):1712–1721.

Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

October 5, 2022

Volume

104

Issue

19

Start / End Page

1712 / 1721

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Retrospective Studies
  • Osteoarthritis
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cohort Studies