Younger vs. older patients exhibit worse outcomes after total ankle arthroplasty
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Key takeaways:
- Younger patients may have worse outcomes after total ankle arthroplasty compared with older patients.
- Higher rates of activity in younger patients may explain increased stress and loading on the prosthesis.
Results published in the Journal of Bone and Joint Surgery showed younger patients had higher rates of complications and implant failure as well as worse functional outcomes after total ankle arthroplasty compared with older patients.
Albert T. Anastasio, MD, and colleagues at the Duke University Medical Center performed a retrospective study of 1,115 patients who underwent primary total ankle arthroplasty (TAA) between March 2000 and October 2020 with a mean follow-up of 5.6 years. Patients were categorized into three cohorts: patients aged younger than 55 years (n = 196), patients aged 55 to 70 years (n = 657) and patients aged older than 70 years (n = 262).
Researchers found patients aged younger than 55 years had the highest rates of reoperation (19.9%), implant failure (5.6%) and polyethylene exchange (7.7%) among all cohorts. Patients aged 55 to 70 years had a reoperation rate of 11.7%, an implant failure rate of 2.9% and a polyethylene exchange rate of 4.3%, whereas patients aged older than 70 years had a reoperation rate of 6.5%, an implant failure rate of 1.1% and a polyethylene exchange rate of 2.3%.
Among all cohorts, patients aged younger than 55 years had the worse mean Foot and Ankle Outcome Score preoperatively and postoperatively except in activities of daily living. Additionally, patients aged younger than 55 years had the highest mean numerical pain score (23.6) compared with patients aged 55 to 70 years (14.4) and patients aged older than 70 years (12.9).
Researchers hypothesized that younger patients may be more active compared with older patients and may put increased stress and loading on the prosthesis which could explain increased complications and worse functional outcomes.
Perspective
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Total joint arthroplasty has been one of the most highly touted and successful surgeries in medicine. Arthritis of the hip and knee is seen more frequently than that of the ankle. As such, total hip and knee replacements are performed more routinely. While total ankle arthroplasty has increased in popularity in recent years, published literature continues to be limited in regard to outcomes and age.
Albert T. Anastasio, MD, and colleagues evaluated 1,115 patients, retrospectively, who underwent a total ankle arthroplasty between March 2000 and October in 2020. Those who were younger than 55 years had a higher reoperation rate, developed implant failure, required polyethylene exchange and did worse on patient-reported outcome measures.
These findings may be a bit surprising as most patients ask to have their surgery done when they are younger and healthier. So, what does this all mean? Perhaps it boils down to the younger patients’ expectations and their overall pain sensitivity to the ankle. It seems that comparing age groups is, in fact, comparing apples to oranges.
Still, this study provides an element of evidence that an ankle replacement on a younger patient may not be as much of a “home run” as we thought. Perhaps focusing on a well-done arthrodesis, which is the more traditional approach for a younger individual, is more ideal.
Overall, there likely are additional factors that have yet to be born out in the literature and this is an area for future investigation. This study may facilitate preoperative counseling to those younger patients with posttraumatic arthritis that is resistant to conservative treatment and looking for surgical management.
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