Inflammatory arthritis may be a risk factor for major complications after TAA

Raikin SM. J Bone Joint Surg. 2010;92:2150-2155. doi:10.2106/JBJS.I.00870.

Underlying inflammatory arthritis was a significant risk factor for major wound complications following total ankle arthroplasty, according to the results of a recently published study.

“We recommend that caution be used when selecting and education patients with inflammatory conditions who are potential candidates for total ankle arthroplasty,” Steven M. Raikin, MD, of Thomas Jefferson University Hospital, and colleagues wrote in their abstract.

For their study, Raikin and his colleagues performed a retrospective chart review for 106 total ankle arthroplasties (TAA). They recorded independent risk factors: age, gender, body mass index, diabetes, smoking, medications, preoperative diagnosis, implant size, tourniquet time, closure method and anticoagulation status. They examined postoperative office notes for wound-related complications. They divided outcomes into three groups: no complications (uncomplicated wound healing), minor complications (wounds requiring only local care/oral antibiotics) and major complications (requiring a return to the operating room).

The investigators compared patients with no complications and those with minor complications, and they found that diabetes was the only factor that significantly increased the complication risk. When the investigators compared patients with no and minor complications to those with major complications, they found that female gender, a history of corticosteroid use and underlying inflammatory arthritis were associated with increased risk. Underlying inflammatory arthritis was the only significant risk factor for major wound complications, according to multivariate logistic regression. The odds ratio indicated a 14.03 times increased reoperation risk, the authors wrote.

As the authors have reported, wound breakdown of the surgical incision is a common complication following ankle replacement surgery. Full-thickness necrosis of the skin and deeper tissues may compromise the final outcome. Screening patients for the risk factors outlined in this article is strongly recommended prior to total ankle arthroplasty.

Of interest, studies have shown that oxygen tensiometry tests have not been useful in predicting which patients are at risk for postoperative wound healing problems after total ankle arthroplasty. This suggests that in a patient with good preoperative pulses, excessive skin traction may contribute to wound problems, more than underlying blood supply, particularly in the ankle where there is a limited soft tissue envelope.

— Carol C. Frey, MD
Orthopedics Today Foot & Ankle Section Editor