Too young for an ankle replacement? Does patient age affect outcomes following total ankle replacement -5 year results

Transcription

1 Too young for an ankle replacement? Does patient age affect outcomes following total ankle replacement -5 year results Ruth Varrall, Jayasree Ramas, Anjani Singh and Malik Siddique AOFAS 2015

2 NO CONFLICT TO DISCLOSE Too young for an ankle replacement? Does patient age affect outcomes following total ankle replacement 5 year results Miss R Varrall My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

3 Introduction Ankle arthritis is multifactorial with etiology including osteoarthritis (OA), rheumatoid arthritis (RA) and post-traumatic arthritis (PTOA). Whilst many patients with OA and RA of the ankle are elderly, PTOA patients are often younger than 60 and looking for a surgical solution to improve their pain whilst maintaining function of the ankle to enable return to work. Surgeons often have reservations in offering this surgery to younger patients, despite the potential benefits of TAR over fusion with regard to preservation of adjacent joints. Many patients are keen for replacement with its potential benefits in the short term and then face revision or fusion later on, both of which are technically difficult and have uncertain outcomes. With minimal long term data over 15 years published for guidance, these younger patients produce a management dilemma. Aims To establish whether ankle replacement provides good outcomes for younger patients. To conclude whether younger age should be a contra-indication for ankle replacement.

4 Methods Prospective audit of a single surgeon series of Mobility total ankle replacements between March 2006 and May 2009 Patients divided into two groups based on age Group A Age >60 years and Group B Age <60 years Data collection pre-op and at 1, 3 and 5 years by independent research physiotherapist included: Patient demographics Co-morbidities Clinical outcomes AOFAS Ankle-Hindfoot score Patient reported outcomes WOMAC function, stiffness, pain SF-36 Patient satisfaction Complications

5 Results Demographics Group A = >60 years Group B = <60 years No of patients Total = 92 Mean BMI P=0.360 % male P=0.189 % right side P=0.53 No significant difference between gender, BMI and laterality Diagnosis Group A > 60y Group B < 60y % osteoarthritis % rheumatoid % PTOA p=0.023 = significantly more OA in group A and PTOA in group B

6 Co-morbidities Mean number comorbidities per patient Group A >60y Group B <60y p=0.008 = significant difference between groups Sub-divided, only statistically significant individual co-morbidity was hypertension (p=0.005) AOFAS score Significant improvement between preop and all following years (up to four years) in both groups (p=0.007) but no difference between groups (p>0.05) Pre-op 1 year 2 years 3 years 4 years Group A >60y Group B <60y

7 Mean WOMAC function score WOMAC Scores Mean WOMAC pain score Pre-op 1 year 3 year 5 year 0 Pre-op 1 year 3 year 5 year Group A >60y Group B <60y Group A >60y Group B <60y Mean WOMAC stiffness score Pre-op 1 year 3 year 5 year Group A >60y Group B <60y P>0.05 for WOMAC pain, function and stiffness no significant difference between groups

8 SF-36 Scores Group A >60years Group B <60years Physical function 100 Physical function 100 Mental health Physical role Mental health Physical role Emotional role 0 Bodily pain Emotional role 0 Bodily pain Social function General health Social function General health Vitality Vitality Pre-op 1 year 3 year 5 year Pre-op 1 year 3 year 5 year No significant difference between the groups for any part of the SF-36 despite Group A starting with higher vitality (p=0.058) and mental health (p=0.052) scores.

9 Satisfaction with pain relief Patient Satisfaction Scores Satisfaction with recreational activities Group B <60y 5 year Group A >60y 5 year Group B <60y 3 year Group A >60y 3 year Group B <60y 1 year Group A >60y 1 year Group B <60y 5 year Group A >60y 5 year Group B <60y 3 year Group A >60y 3 year Group B <60y 1 year Group A >60y 1 year Very dissatisfied Somewhat dissatisfied Somewhat satisfied Very satisfied Satisfaction with return to ADLs Group B <60y 5 year Group A >60y 5 year Group B <60y 3 year Group A >60y 3 year Group B <60y 1 year Group A >60y 1 year Very dissatisfied Somewhat dissatisfied Somewhat satisfied Very satisfied Very dissatisfied Somewhat dissatisfied Somewhat satisfied Very satisfied Overall satisfaction with surgery Group B <60y 5 year Group A >60y 5 year Group B <60y 3 year Group A >60y 3 year Group B <60y 1 year Group A >60y 1 year Very dissatisfied Somewhat dissatisfied Somewhat satisfied Very satisfied No significant difference between groups in all satisfaction scores (p>0.05)

10 Complications Group A >60 years Group B <60 years Deceased 4 2 Deep Infection 0 1 Superficial Infection 2 2 Medial Pain 3 1 Lateral Pain/ Impingement 1 1 Medial Malleolus Fracture 4 1 Revision 0 1 Limitations Only up to 5 years data difficult to make long term conclusions AOFAS scores documented until 4 years (lack of funding) Need for usage of validated PROMs scores specific to TAR

11 Discussion Group A >60 years Group B <60 years Etiology Significantly more OA Significantly more PTOA Co-morbidities Significantly more AOFAS Significant improvement from pre-op WOMAC No difference No difference Significant improvement from pre-op SF-36 No difference No difference Satisfaction No difference between groups

12 Conclusions Despite only 5 years follow up, there were satisfactory outcomes for the under 60s group which were similar to the over 60s group We feel that younger age alone should not be a contra-indication to TAR Longer term results with greater numbers are awaited Survivorship data needed to make firm conclusions as to whether patients under 60 should be offered TAR Important to develop and use validated scoring systems specific to TAR