Association of Preexisting Triple Fusion and Arthroscopic Ankle Arthrodesis nonunion.

IF 2.4 2区医学 Q2 ORTHOPEDICS

Foot & Ankle International Pub Date : 2023-07-01 Epub Date: 2023-05-22 DOI:10.1177/10711007231171077

Alex Woods, Adrian Kendal, Shwan Henari, Mark Rogers, Rick Brown, Robert Sharp, Constantinos L Loizou

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Abstract

Background: Arthroscopic ankle arthrodesis (AAA) is a successful treatment for end-stage ankle arthritis. A significant early complication of AAA is symptomatic nonunion. Published nonunion rates range from 8% to 13%. Longer term, there is concern that it predisposes to subtalar joint (STJ) fusion. To better understand these risks, we undertook a retrospective investigation of primary AAA.

Methods: All adult AAA cases conducted at our institution over a 10-year period were reviewed. A total of 284 eligible AAA cases in 271 patients were analyzed. The primary outcome measure was radiographic union. Secondary outcome measures included reoperative rate, postoperative complications and subsequent STJ fusion. Univariate and multivariate logistic regression analysis was performed to identify nonunion risk factors.

Results: The overall nonunion rate was 7.7%. Smoking (odds ratio [OR] 4.76 [1.67, 13.6], P = .004) and previous triple fusion (OR 40.29 [9.46, 171.62], P < .001) were independent risk factors on univariate analysis. Only prior triple fusion persisted as a major risk factor associated with nonunion on multivariate analysis (OR 18.3 [3.4, 99.7], P < .001). Seventy percent of patients with a previous triple fusion went on to develop nonunion compared to 5.5% of those without. Increasing age, obesity, surgical grade, diabetes, postoperative weightbearing plan, steroid use, and inflammatory arthropathy were not significant risk factors. The leading cause of reoperation was hardware removal (18%). There were 5 superficial (1.8%) and 4 deep (1.4%) infections. Eleven (4.2%) required subsequent STJ fusion. The "survivorship" of STJ post AAA was 98%, 85%, and 74% at 2, 5, and 9 years, respectively.

Conclusion: As the largest study of AAA in the literature, our findings suggest prior triple fusion is a major independent risk factor for AAA nonunion. These patients should be counseled of this high risk and may benefit from alternative surgical options.

Level of evidence: Level III, retrospective cohort study.

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三重融合术与关节镜下踝关节固定术不愈合的关系

背景：关节镜下踝关节置换术（AAA）是治疗终末期踝关节炎的一种成功方法。踝关节置换术的一个重要早期并发症是无症状的不愈合。已公布的不愈合率在 8% 到 13% 之间。从长远来看，人们担心它容易导致距下关节（STJ）融合。为了更好地了解这些风险，我们对原发性 AAA 进行了回顾性调查：方法：我们回顾了本院 10 年来的所有成人 AAA 病例。共分析了 271 名患者中符合条件的 284 例 AAA。主要结果指标为放射学结合率。次要结果指标包括再手术率、术后并发症和随后的 STJ 融合。通过单变量和多变量逻辑回归分析来确定不愈合的风险因素：总的不愈合率为 7.7%。吸烟（几率比 [OR] 4.76 [1.67, 13.6]，P = .004）和既往三次融合术（OR 40.29 [9.46, 171.62]，P P 结论：作为文献中最大规模的 AAA 研究，我们的研究结果表明，既往的三联融合术是 AAA 非愈合的主要独立危险因素。应告知这些患者这一高风险，并让他们从其他手术方案中获益：III级，回顾性队列研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Foot & Ankle International 医学-整形外科

CiteScore

5.60

自引率

22.20%

发文量

144

审稿时长

2 months

期刊介绍： Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers. The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008. The journal focuses on the following areas of interest: • Surgery • Wound care • Bone healing • Pain management • In-office orthotic systems • Diabetes • Sports medicine