Experience, early complications and learning curve for total ankle replacement with two and three components

Abstract

Background: Total ankle replacement (TAR) is an alternative for the treatment of the end-stage of ankle osteoarthritis. However, this surgery is technically demanding and is not exempt from complications. There is a learning curve during its initial use. The aim of this article is to determine the impact of the learning curve in the performance of three-component arthroplasty, and if that curve has implications for two-component arthroplasty. Methods: A prospective cohort study was conducted. Patients with advanced osteoarthrosis (OA) of the ankle who underwent TAR were included. The first 41 patients who underwent a three-component implant (HINTEGRA) were compared, dividing them into two groups. (First 20 and second 21) And in a second analysis we compared the same 20 first patients with the first 17 who underwent a two-component implant (INFINITY). We reviewed our database to determine only the presence of perioperative complications within the first six weeks after surgery. Results: 57 patients were included in the study. In group A, five complications occurred, including 3 intraoperative fractures, a flexor hallucis longus tendon injury and a superficial surgical wound infection (25%). In group B, only one complication occurred, which was superficial infection of the operative wound (5%). And in group C a complication was registered that corresponded to an intraoperative fracture (6%). Conclusion: With our available numbers, we believe that early perioperative complications decrease significantly in the last series of patients regardless of the prosthesis used, concluding that the learning curve and an adequate number of cases is essential to optimize the results in a complex surgery such as total ankle replacement.