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. 2023 Nov 1;105-B(11):1184-1188.
doi: 10.1302/0301-620X.105B11.BJJ-2023-0199.R1.

Survival of revision ankle arthroplasty

Toby Jennison  1   2 , Obioha C Ukoumunne  3 , Sallie Lamb  3 , Andrew J Goldberg  4   5   6 , Ian Sharpe  2
Affiliations

Survival of revision ankle arthroplasty

Toby Jennison et al. Bone Joint J. .

Abstract

Aims: The number of revision total ankle arthroplasties (TAAs) which are undertaken is increasing. Few studies have reported the survival after this procedure. The primary aim of this study was to analyze the survival of revision ankle arthroplasties using large datasets. Secondary aims were to summarize the demographics of the patients, the indications for revision TAA, further operations, and predictors of survival.

Methods: The study combined data from the National Joint Registry and NHS Digital to report the survival of revision TAA. We have previously reported the failure rates and risk factors for failure after TAA, and the outcome of fusion after a failed TAA, using the same methodology. Survival was assessed using life tables and Kaplan Meier graphs. Cox proportional hazards regression models were fitted to compare failure rates.

Results: A total of 228 patients underwent revision TAA. The mean follow-up was 2.6 years (SD 2.0). The mean time between the initial procedure and revision was 2.3 years (SD 1.8). The most commonly used implant was the Inbone which was used in 81 patients. A total of 29 (12.7%) failed; nine (3.9%) patients underwent a further revision, 19 (8.3%) underwent a fusion, and one (0.4%) had an amputation. The rate of survival was 95.4% (95% confidence interval (CI) 91.6 to 97.5) at one year, 87.7% (95% CI 81.9 to 91.7; n = 124) at three years and 77.5% (95% CI 66.9 to 85.0; n = 57) at five years. Revision-specific implants had a better survival than when primary implants were used at revision. A total of 50 patients (21.9%) had further surgery; 19 (8.3%) underwent reoperation in the first 12 months. Cox regression models were prepared. In crude analysis the only significant risk factors for failure were the use of cement (hazard ratio (HR) 3.02 (95% CI 1.13 to 8.09)) and the time since the primary procedure (HR 0.67 (95% CI 0.47 to 0.97)). No risk factors for failure were identified in multivariable Cox regression modelling.

Conclusion: Revision TAAs have good medium term survival and low rates of further surgery. New modular revision implants appear to have improved the survival compared with the use of traditional primary implants at revision.

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Conflict of interest statement

I. Sharpe reports consulting fees from Stryker, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Stryker and Paragon P28, and stock or stock options in the Standing CT Company, all of which are unrelated to this article. A. J. Goldberg reports a grant from NIHR HTA for TARVA and a grant from Versus Arthritis for OARS, related to this article, as well as consulting fees and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Styker and Paragon P28, board/committee membership on the National Joint Registry, and stock or stock options in the Standing CT Company, Elstree Waterfront Outpatients, and SOTA Orthopaedics, all of which are unrelated to this article.

References

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