Comparing 90-day Medical Complications of Primary vs Revision Total Ankle Arthroplasty

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: As the reliance on total ankle arthroplasty (TAA) for managing end-stage arthritis continues to grow, the burden of revision surgeries is expected to increase. While the incidence of medical complications following revision for other joint arthroplasty surgeries compared to the primary arthroplasty procedure is well-documented, there is a notable gap in the literature comparing complications in primary versus revision TAA. The present study aims to evaluate 90-day medical complications after revision TAA as compared to primary TAA. Methods: Patients who underwent primary and revision TAA were identified by CPT procedure codes using a national administrative claims database, which contains over 170 million patients between January 2010 and April 2023. Revision TAA patients were propensity-score matched by age, gender, and Charlson Comorbidity Index (CCI) to the primary TAA cohort in a 2:1 ratio. Univariate analysis was performed with Chi-Square testing to evaluate ninety-day medical complications, identified via ICD-9 and ICD-10 diagnosis codes. Results were reported as risk ratios with 95% confidence intervals. Results: After matching, 4,108 total patients were included in this study; 2,718 in the primary TAA cohort and 1,390 in the revision TAA cohort. For 90-day medical complications, the revision cohort had a significantly higher risk of surgical site infection (SSI) (RR: 3.83; CI: 2.70-5.43), renal failure (RR: 1.96; CI: 1.14-3.35), arrhythmia (RR:1.55; CI: 1.14-2.11), blood transfusion (RR: 3.58; CI: 1.32-9.67) and sepsis (RR: 2.22; CI: 1.11-4.42). Conclusion: This study shows revision TAA has a significantly higher risk of complications such as surgical site infections, renal failure, arrhythmia, blood transfusions, and sepsis. These increased risks may reflect the added complexity and duration of revision surgery. These findings highlight the importance of preoperative medical optimization, informed shared decision-making, and perioperative awareness to minimize morbidity. As utilization of TAA increases, revision arthroplasty numbers can be anticipated to rise as well. Understanding and addressing these risks is essential for improving patient outcomes and guiding clinical practice. Further studies are needed to explore strategies for minimizing complications in revision TAA patients.