RESUMO
BACKGROUND: While total ankle arthroplasty (TAA) has evolved over the years with improved designs and enhanced bony fixation methods, it remains a technically demanding procedure with a risk of early postoperative complications. One of the most common complications associated with TAA is medial and lateral gutter ankle impingement, which can lead to issues such as increased pain and decreased range of motion (ROM). However, there is a paucity of information in the literature discussing the impact of certain risk factors on gutter impingement complications. METHODS: A retrospective analysis was conducted on a cohort of patients who underwent a TAA at a single institution from 2003 to 2019 with a minimum of 2-year follow-up. Patient were identified as having gutter impingement based on diagnostic imaging and/or clinical examination. Data collection included demographics, implant type, follow-up time, and co-morbidities. Multivariate odds ratios (OR) of experiencing gutter impingement were calculated for perioperative variables. RESULTS: The study included a total of 908 patients who underwent TAA with a minimum of 2 year follow up and 121 patients (13.3 %) who subsequently experienced gutter impingement. The average follow-up time was 5.84 + /- 3.07 years. There were 178 patients under 55 years old, 495 patients aged 55 to 70, and 235 patients over 70 years old. A higher rate of gutter impingement was observed in patients under 55 years of age compared to those aged 55 to 70 and over 70 (20.8 % vs. 13.5 % vs. 7.2 %; p < 0.01). Multivariable logistic regression revealed that patient age was significantly correlated with gutter impingement following TAA, with an OR of 0.94 (CI: 0.91-0.98; p < 0.01). CONCLUSION: This study demonstrated increased incidence of gutter impingement in younger patients who underwent TAA. Propensity for scar tissue formation may be higher in this population. Scar tissue deposition following TAA can cause narrowing of the medial and lateral clear spaces, potentially leading to gutter impingement. Additionally, younger patients may have increased activity demands, which subsequently may cause higher rates of symptomatic impingement. As increased impingement after TAA may require the need for additional debridement surgeries, it is important to understand the intricate relationship between age and gutter impingement for managing patient expectations following TAA. LEVEL OF EVIDENCE: Level III.
RESUMO
BACKGROUND: Collapse of the talus and peri-talar arthritis pose treatment challenges due to the anatomy and location of the talus as a keystone of the foot and ankle. Custom 3D-printed total talus replacement (TTR) and combined total ankle total talus replacement (TATTR) have emerged as treatment options for these pathologies. However, the safety and efficacy of these implants is unknown due to the limited number of cases and short follow-up durations. METHODS: This was a retrospective study to assess surgical outcomes of patients who underwent a TTR and TATTR with or without subtalar fusion. Patient demographics, intraoperative parameters, device related surgical and non-surgical events, imaging and clinical evaluations, and patient reported outcome (PRO) measures were compiled. RESULTS: A total of 38 patients received a custom 3D-printed implant with mean follow-up time of 22.1 (range: 12-45) months. In this cohort, 7 (18.4 %) required secondary surgery and 3 (7.9 %) required implant removal. Multivariate logistic regression revealed that patient diagnosis of depression was a significant predictor of secondary surgery with an OR 17.50 (p = 0.037). Significant postoperative improvements were observed in the talocalcaneal height (p = 0.005) and talar declination angle (p = 0.013) for the TATTR group. VAS and PROMIS pain interference (PI) scores demonstrated an initial significant improvement in pain, but this improvement did not maintain significance at most recent follow-up. However, there was a significant increase in the PROMIS physical function (PF) scores (p = 0.037) at most recent follow-up. CONCLUSION: These results demonstrate that TTR and TATTR provide significant improvement in post-operative radiographic foot and ankle alignment and physical function at the two-year timepoint. PRO findings suggest that patients are more active after surgery. Surgeons considering proceeding with either of these procedures should counsel patients about pain and functional outcomes as well as realistic expectations in patients with depression. LEVEL OF EVIDENCE: Level 3.