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Younger Patients Undergoing Total Ankle Arthroplasty Experience Higher Complication Rates and Worse Functional Outcomes.

Publication ,  Journal Article
Anastasio, AT; Kim, BI; Wixted, CM; DeOrio, JK; Nunley, JA; Easley, ME; Adams, SB
Published in: J Bone Joint Surg Am
January 3, 2024

BACKGROUND: Although many patients with posttraumatic ankle arthritis are of a younger age, studies evaluating the impact of age on outcomes of primary total ankle arthroplasty (TAA) have revealed heterogenous results. The purpose of the present study was to determine the effect of age on complication rates and patient-reported outcomes after TAA. METHODS: We retrospectively reviewed the records of 1,115 patients who had undergone primary TAA. The patients were divided into 3 age cohorts: <55 years (n = 196), 55 to 70 years (n = 657), and >70 years (n = 262). Demographic characteristics, intraoperative variables, postoperative complications, and patient-reported outcome measures were compared among groups with use of univariable analyses. Competing-risk regression analysis with adjustment for patient and implant characteristics was performed to assess the risk of implant failure by age group. The mean duration of follow-up was 5.6 years. RESULTS: Compared with the patients who were 55 to 70 years of age and >70 years of age, those who were <55 years of age had the highest rates of any reoperation (19.9%, 11.7%, and 6.5% for the <55, 55 to 70, and >70-year age groups, respectively; p < 0.001), implant failure (5.6%, 2.9%, and 1.1% for the <55, 55 to 70, and >70-year age groups, respectively; p = 0.019), and polyethylene exchange (7.7%, 4.3%, and 2.3% for the <55, 55 to 70, and >70-year age groups, respectively; p = 0.021). Competing-risk regression revealed a decreased risk of implant failure for patients who were >70 of age compared with those who were <55 years of age (hazard ratio [HR], 0.21 [95% confidence interval (CI), 0.05 to 0.80]; p = 0.023) and for patients who were 55 to 70 years of age compared with those who were <55 years of age (HR, 0.35 [95% CI, 0.16 to 0.77]; p = 0.009). For all subscales of the Foot and Ankle Outcome Score (FAOS) measure except activities of daily living, patients who were <55 years of age reported the lowest (worst) mean preoperative and postoperative scores compared with those who were 55 to 70 years of age and >70 years of age (p ≤ 0.001). Patients who were <55 years of age had the highest mean numerical pain score at the time of the latest follow-up (23.6, 14.4, 12.9 for the <55, 55 to 70, and >70-year age groups, respectively; p < 0.001). CONCLUSIONS: Studies involving large sample sizes with intermediate to long-term follow-up are critical to reveal age-related impacts on outcomes after TAA. In the present study, which we believe to be the largest single-institution series to date evaluating the effect of age on outcomes after TAA, younger patients had higher rates of complications and implant failure and fared worse on patient-reported outcome measures. LEVEL OF EVIDENCE: Prognostic 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

January 3, 2024

Volume

106

Issue

1

Start / End Page

10 / 20

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Reoperation
  • Orthopedics
  • Middle Aged
  • Humans
  • Arthroplasty, Replacement, Ankle
  • Ankle Joint
  • Ankle
  • Aged
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Anastasio, A. T., Kim, B. I., Wixted, C. M., DeOrio, J. K., Nunley, J. A., Easley, M. E., & Adams, S. B. (2024). Younger Patients Undergoing Total Ankle Arthroplasty Experience Higher Complication Rates and Worse Functional Outcomes. J Bone Joint Surg Am, 106(1), 10–20. https://doi.org/10.2106/JBJS.23.00122
Anastasio, Albert T., Billy I. Kim, Colleen M. Wixted, James K. DeOrio, James A. Nunley, Mark E. Easley, and Samuel B. Adams. “Younger Patients Undergoing Total Ankle Arthroplasty Experience Higher Complication Rates and Worse Functional Outcomes.J Bone Joint Surg Am 106, no. 1 (January 3, 2024): 10–20. https://doi.org/10.2106/JBJS.23.00122.
Anastasio AT, Kim BI, Wixted CM, DeOrio JK, Nunley JA, Easley ME, et al. Younger Patients Undergoing Total Ankle Arthroplasty Experience Higher Complication Rates and Worse Functional Outcomes. J Bone Joint Surg Am. 2024 Jan 3;106(1):10–20.
Anastasio, Albert T., et al. “Younger Patients Undergoing Total Ankle Arthroplasty Experience Higher Complication Rates and Worse Functional Outcomes.J Bone Joint Surg Am, vol. 106, no. 1, Jan. 2024, pp. 10–20. Pubmed, doi:10.2106/JBJS.23.00122.
Anastasio AT, Kim BI, Wixted CM, DeOrio JK, Nunley JA, Easley ME, Adams SB. Younger Patients Undergoing Total Ankle Arthroplasty Experience Higher Complication Rates and Worse Functional Outcomes. J Bone Joint Surg Am. 2024 Jan 3;106(1):10–20.

Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

January 3, 2024

Volume

106

Issue

1

Start / End Page

10 / 20

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Reoperation
  • Orthopedics
  • Middle Aged
  • Humans
  • Arthroplasty, Replacement, Ankle
  • Ankle Joint
  • Ankle
  • Aged