Younger patients have more complications, worse outcomes after total ankle arthroplasty
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Key takeaways:
- Younger patients had more complications and worse patient-reported outcomes than older patients after total ankle arthroplasty.
- Improvements were less pronounced in younger patients than in older patients.
LOUISVILLE, Ky. — Results presented here showed younger patients had higher complication rates and worse patient-reported outcomes compared with older patients following primary total ankle arthroplasty.
“While the youngest cohort may have the worst pre- and postoperative scores, the delta is still positive,” Albert T. Anastasio, MD, said in his presentation at the American Orthopaedic Foot & Ankle Society Annual Meeting. “These patients do a lot better; they just may not be able to expect the same magnitude of improvement as an older patient. I think this makes sense intuitively.”
In a retrospective study, Anastasio and colleagues prospectively collected data for 1,071 total ankle arthroplasty procedures performed at Duke University between 2001 and 2020 to determine the association between age and complication rates, as well as patient-reported outcomes following total ankle arthroplasty.
Researchers categorized patients into three cohorts based on age: patients younger than 55 years (n = 197), patients aged 55 to 70 years (n = 658) and patients older than 70 years (n = 262). Patient-reported outcome measures included Foot and Ankle Disability Index, Short Musculoskeletal Function Assessment, SF-36 and Foot and Ankle Outcome Score (FAOS) subscales.
Anastasio said patients younger than 55 years had higher rates of reoperation, implant failure and polyethylene exchange compared with patients aged 55 to 70 years and patients older than 70 years. He added patients in the youngest group also had the lowest preoperative and postoperative scores in each FAOS subscale measurement compared with the middle-aged and older patient groups. At final follow-up, patients in the youngest group had the highest mean numerical pain score, according to Anastasio.
“I would like to see more studies involving larger sample sizes with mid[term] to longer-term follow-up and outcomes after total ankle,” Anastasio said.
“We can perform systematic reviews and meta-analysis and look at different institutions and larger data to help us arrive at the ‘right answer,’” he continued. “And as much as we hate to say it, we can get on the level of our adult reconstruction colleagues. They have huge data, and that allows them to arrive at a much closer answer to what would be considered the right answer.”
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Anastasio AT, et al. Younger patients undergoing total ankle arthroplasty experience higher complication rates and worse functional outcome scores. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 20-23, 2023; Louisville, Kentucky.
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