Does Prior Surgery Affect Total Ankle Complication and Failure Rates?

CATEGORY: Ankle Arthritis; Ankle INTRODUCTION/PURPOSE: Given that most ankle replacements are post-traumatic in origin, it is important to investigate if prior interventions can affect a patient’s functional outcome or the possibility of having a complication. Prior surgeries create scar, incisions, and possible affect bone health that could interfere with healing. The purpose of the study is to assess the pain and functional temporal outcomes of patients with and without prior surgeries in the ipsilateral ankle. We hypothesize that those with a previous ipsilateral ankle procedure will not have an increased complication rate or worse functional outcomes. METHODS: We retrospectively identified a consecutive series of 100 primary TARs with a prior procedure who were followed for a minimum of 3 years. The follow-up time points considered were 0, 6, 12, and 36 months. Outcomes were measured using AOFAS, VAS, SF12, and range of motion scores. The mean patient age was 56.5 +- 13.4 years. Sixty-four patients had previous interventions which included osteosynthesis (49), arthroscopy (11), hardware removal (25), arthrodesis (3), prosthesis (1), open fracture (9), and other open surgery (12). Within-group comparisons were performed using one-way repeated-measures ANOVA (1-w rANOVA), analyzing temporal course of clinical data (comparisons between different time points) between the groups. To compare the time course of clinical measures between the two groups, 2-w rANOVAs were performed. Data and statistical analysis were conducted using Matlab (MathWorks, Natick, MA). RESULTS: For each type of intervention, every outcome was compared to test whether presurgery interventions have an influence on the temporal evolution of the outcomes. The two groups did not show any difference on the temporal evolution of the outcomes. The type of intervention did have a weak effect on outcomes. Treatment of previous open fractures was the only pre- surgical intervention that showed a statistically significant difference in temporal evolution of functional and pain outcomes between intervention and non-intervention groups. No significant correlations were found between all outcomes and the time between the last intervention and prosthesis. Using Fisher’s-exact test, there was not a significant association between the those who had previous surgery and those who did not and the rate of complication and revision (p =0.10). CONCLUSION: A pre-operative discussion should center on potential complications and predicted functional outcomes. The presence, type, and timing of an intervention prior to an ankle replacement does not strongly affect the temporal outcomes of pain and functional outcome scores. Furthermore, the complication or revision rate is not affected by prior surgeries.