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Poor prosthesis survival and function after component exchange of total ankle prostheses

Kamrad, Ilka LU ; Henricsson, Anders; Karlsson, Magnus LU ; Magnusson, Håkan I LU ; Nilsson, Jan-Åke LU ; Carlsson, Åke LU and Rosengren, Björn LU (2015) In Acta Orthopaedica 86(4). p.407-411
Abstract

BACKGROUND AND PURPOSE: In failed total ankle replacements (TARs), fusion is often the procedure of preference; the outcome after exchanging prosthetic components is debated. We analyzed prosthetic survival, self-reported function, and patient satisfaction after component exchange. Patients and methods We identified patients in the Swedish Ankle Registry who underwent exchange of a tibial and/or talar component between January 1, 1993 and July 1, 2013 and estimated prosthetic survival by Kaplan-Meier analysis. We evaluated the patient-reported outcome measures (PROMs) SEFAS, EQ-5D, EQ-VAS, SF-36, and patient satisfaction by direct questions.

RESULTS: 69 patients underwent revision TAR median 22 (0-110) months after the primary... (More)

BACKGROUND AND PURPOSE: In failed total ankle replacements (TARs), fusion is often the procedure of preference; the outcome after exchanging prosthetic components is debated. We analyzed prosthetic survival, self-reported function, and patient satisfaction after component exchange. Patients and methods We identified patients in the Swedish Ankle Registry who underwent exchange of a tibial and/or talar component between January 1, 1993 and July 1, 2013 and estimated prosthetic survival by Kaplan-Meier analysis. We evaluated the patient-reported outcome measures (PROMs) SEFAS, EQ-5D, EQ-VAS, SF-36, and patient satisfaction by direct questions.

RESULTS: 69 patients underwent revision TAR median 22 (0-110) months after the primary procedure. 24 of these failed again after median 26 (1-110) months. Survival analysis of revision TAR showed a 5-year survival rate of 76% and a 10-year survival of 55%. 29 patients with first revision TAR in situ answered the PROMs at mean 8 (1-17) years after revision and had the following mean scores: SEFAS 22, SF-36 physical 37 and mental 49, EQ-5D index 0.6, and EQ-VAS 64. 15 of the patients were satisfied, 5 were neither satisfied nor dissatisfied, and 9 were dissatisfied.

INTERPRETATION: Revision TAR had a 10-year survival of 55%, which is lower than the 10-year survival of 74% for primary TAR reported from the same registry. Only half of the patients were satisfied. Future studies should show which, if any, patients benefit from revision TAR and which patients should rather be fused directly.

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published
subject
keywords
Adult, Aged, Ankle Joint, Arthritis, Rheumatoid, Arthroplasty, Replacement, Ankle, Female, Humans, Joint Prosthesis, Kaplan-Meier Estimate, Longitudinal Studies, Male, Middle Aged, Osteoarthritis, Outcome Assessment (Health Care), Patient Satisfaction, Prognosis, Registries, Reoperation, Retrospective Studies, Sweden, Talus, Tibia, Treatment Outcome, Journal Article
in
Acta Orthopaedica
volume
86
issue
4
pages
5 pages
publisher
Taylor & Francis
external identifiers
  • pmid:25673048
  • wos:000359106700003
  • scopus:84937832271
ISSN
1745-3682
DOI
10.3109/17453674.2015.1018760
language
English
LU publication?
yes
id
6fa63efc-0713-4625-989e-a390e45cd2ff (old id 5144817)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/25673048?dopt=Abstract
date added to LUP
2015-03-07 11:46:32
date last changed
2017-11-19 03:15:45
@article{6fa63efc-0713-4625-989e-a390e45cd2ff,
  abstract     = {<p>BACKGROUND AND PURPOSE: In failed total ankle replacements (TARs), fusion is often the procedure of preference; the outcome after exchanging prosthetic components is debated. We analyzed prosthetic survival, self-reported function, and patient satisfaction after component exchange. Patients and methods We identified patients in the Swedish Ankle Registry who underwent exchange of a tibial and/or talar component between January 1, 1993 and July 1, 2013 and estimated prosthetic survival by Kaplan-Meier analysis. We evaluated the patient-reported outcome measures (PROMs) SEFAS, EQ-5D, EQ-VAS, SF-36, and patient satisfaction by direct questions.</p><p>RESULTS: 69 patients underwent revision TAR median 22 (0-110) months after the primary procedure. 24 of these failed again after median 26 (1-110) months. Survival analysis of revision TAR showed a 5-year survival rate of 76% and a 10-year survival of 55%. 29 patients with first revision TAR in situ answered the PROMs at mean 8 (1-17) years after revision and had the following mean scores: SEFAS 22, SF-36 physical 37 and mental 49, EQ-5D index 0.6, and EQ-VAS 64. 15 of the patients were satisfied, 5 were neither satisfied nor dissatisfied, and 9 were dissatisfied.</p><p>INTERPRETATION: Revision TAR had a 10-year survival of 55%, which is lower than the 10-year survival of 74% for primary TAR reported from the same registry. Only half of the patients were satisfied. Future studies should show which, if any, patients benefit from revision TAR and which patients should rather be fused directly.</p>},
  author       = {Kamrad, Ilka and Henricsson, Anders and Karlsson, Magnus and Magnusson, Håkan I and Nilsson, Jan-Åke and Carlsson, Åke and Rosengren, Björn},
  issn         = {1745-3682},
  keyword      = {Adult,Aged,Ankle Joint,Arthritis, Rheumatoid,Arthroplasty, Replacement, Ankle,Female,Humans,Joint Prosthesis,Kaplan-Meier Estimate,Longitudinal Studies,Male,Middle Aged,Osteoarthritis,Outcome Assessment (Health Care),Patient Satisfaction,Prognosis,Registries,Reoperation,Retrospective Studies,Sweden,Talus,Tibia,Treatment Outcome,Journal Article},
  language     = {eng},
  number       = {4},
  pages        = {407--411},
  publisher    = {Taylor & Francis},
  series       = {Acta Orthopaedica},
  title        = {Poor prosthesis survival and function after component exchange of total ankle prostheses},
  url          = {http://dx.doi.org/10.3109/17453674.2015.1018760},
  volume       = {86},
  year         = {2015},
}