Evidence-based classification of complications in total ankle arthroplasty.
BACKGROUND
Total ankle arthroplasty (TAA) has become a viable treatment for end-stage ankle arthrosis. Current literature on survival rates and complications of TAA consist of mostly retrospective Level IV papers that do not provide a system for classifying complications. The aim of the current review is to provide a summary of TAA implant survival and complication rates from current literature on outcomes of second or third generation ankle prostheses and subsequently propose a classification system.


METHODS
A literature review was used to identify articles reporting complications and failures of TAA ankle prostheses. Inclusion criteria included studies with at least 25 cases and a minimum of 24 months followup.


RESULTS
Twenty studies met the inclusion criteria. The percentage of failed TAA reported for the short- and intermediate-term followup in this review ranged from 1.3 to 32.3 % with an overall mean of 12.4 % failure at 64 months. Nine main complications of TAA were identified.


CONCLUSIONS
Deep infection, aseptic loosening and implant failure should be considered ;;high-grade'' complications since they will result in failure greater than 50% of the time. Technical error, subsidence and postoperative bone fracture should be considered "medium-grade'', while intra-op bone fractures and wound healing problems should be considered "low-grade''. We believe this review provides the groundwork for uniform complication reporting in TAA and allows the development of a classification system that will provide prognostic information that may serve to guide postoperative care of patients receiving TAA.
Dalhousie University, Division of Orthopaedics, Room 4867 Halifax Infirmary, Queen Elizabeth II Health Sciences Center, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada. markglazebr@ns.sympatico.ca
Mark A
MA
Glazebrook
Kory
K
Arsenault
Michael
M
Dunbar
D000843:Ankle Joint / Q000601:surgery*; D019643:Arthroplasty, Replacement; D019317:Evidence-Based Medicine; D006801:Humans; D011183:Postoperative Complications / Q000145:classification*; D011475:Prosthesis Failure