Complications of total ankle arthroplasty versus ankle arthrodesis: A systematic review and meta-analysis with trial sequential analysis.

Autor: Boey JJE; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore., Toh RX; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore. Electronic address: toh.rui.xiang@singhealth.com.sg., Loh YC; Faculty of Medicine, University of New South Wales, Sydney, Australia., Zhang C; Faculty of Medicine, University of New South Wales, Sydney, Australia., Ling RR; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Australia and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Anaesthesia, National University Hospital, National University Health System, Singapore., Li ZX; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore., Mohamed Buhary KS; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore., Tay KS; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
Jazyk: angličtina
Zdroj: Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons [Foot Ankle Surg] 2024 Dec 16. Date of Electronic Publication: 2024 Dec 16.
DOI: 10.1016/j.fas.2024.11.008
Abstrakt: Background: Ankle osteoarthritis affects 1-3 % of all adults. Contemporary evidence is equivocal when comparing the outcomes and complications of TAA and AA. This review aims to compare the complications between TAA and AA to provide surgeons with an additional perspective when managing ESAO.
Methods: We conducted a systematic review and meta-analysis, searching four international databases from inception until 21 Jan 2024 for RCTs and score-matched studies reporting on TAA or AA for ESAO. Score-matched studies were included if matching accounted for four or more covariates related to patient demographics and comorbidities. Random-effects (DerSimonian and Laird) meta-analyses were conducted. The primary outcome was complications stratified into total, major, and minor as guided by previous studies. We rated intra-study risk of bias using the Cochrane Risk of Bias 2 tool and the Newcastle-Ottawa Scale. We assessed the certainty of evidence using the GRADE approach.
Results: 5 studies (2 RCTs and 3 score-matched studies) totalling 13,957 patients (6975 TAA, 6982 AA) were included in the meta-analysis. The pooled RR for total complications was 0.95 (95 %-CI: 0.85 to 1.08, p = 0.45, moderate certainty, favourable towards AA). The pooled RR for major complications was 1.18 (95 %-CI: 0.70 to 1.98; p = 0.54, low certainty, favouring TAA) and for minor complications was 0.96 (95 %-CI: 0.75 to 1.22; p = 0.73, moderate certainty, favouring AA).
Conclusion: Previous reviews have recognised TAA and AA as equivocally effective surgical options for patients with ESAO. Our review may suggest that TAA and AA have similar rates of major and minor complications. Surgeons should consider the specific complications for TAA and AA despite the similar rates of complications when counselling patients.
Protocol Registration: CRD42023389626.
Competing Interests: Declaration of Competing Interest The abovementioned authors declare that we do not have any conflicting interests with the topic explored in this review. Tay Kae Sian has received honoraria as a consultant for matters not related to the topic from Synthes and Arthrex Ltd. Ryan Ruiyang Ling acknowledges research funding support outside of this work from the Clinician Scientist Development Unit, Yong Loo Lin School of Medicine, Singapore.
(Copyright © 2024 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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