Younger Age Correlates with Increased Gutter Impingement Rates after Total Ankle Arthroplasty

Submission Type: Total Ankle Arthroplasty Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: While total ankle arthroplasty (TAA) has evolved over the years with improved designs and fixation methods, it remains a technically demanding procedure with substantial early postoperative complication rates. One of the most common complications associated with TAA is medial and lateral gutter ankle impingement, which can lead to issues such as increased pain and more outcomes. However, there is a paucity of information in the literature discussing the impact of certain risk factors on gutter impingement complications. Methods: A retrospective analysis was conducted on a cohort of patients who underwent a revision TAA at a single institution from 2003 to 2019 with a minimum of 2-year follow-up. Patient were identified as having gutter impingement based on diagnostic imaging and/or clinical examination. Data collection included demographics, implant type, follow-up time, and co-morbidities. Multivariate odds ratios (OR) of experiencing gutter impingement were calculated for perioperative variables. Results: The study included a total of 908 patients who underwent TAA with 121 patients (13.3%) who subsequently experienced gutter impingement. The average follow-up time was. 5.84 +/- 3.07 years. There were 178 patients under 55 years old, 495 patients aged 55 to 70, and 235 patients over 70 years old. A higher rate of gutter impingement was observed in patients under 55 compared to those aged 55 to 70 and over 70 (20.8% vs. 13.5% vs. 7.2%; p< 0.01). Multivariable logistic regression revealed that patient age was a significant predictor of gutter impingement following TAA with an OR 0.96 (p < 0.01). Conclusion: This study demonstrated increased prevalence of gutter impingement in younger patients who underwent TAA. Propensity for scar tissue formation may be higher in this population. Scar tissue following surgery can cause the narrowing of the medial and lateral gutter potentially leading to gutter impingement. Scar tissues may compress the prosthetic components of the ankle leading to pain, swelling, and limited range of motion in the ankle joint. Increased impingement after TAA may require the need for additional debridement surgeries. Grasping the intricate relationship between age, scar tissue formation, and gutter impingement is vital for managing complications following TAA.