Total ankle replacement in obese patients: component stability, weight change, and functional outcome in 118 consecutive patients.

Clinic of Orthopaedic Surgery, Kantonsspital Liestal, Liestal, Switzerland.
Foot & Ankle International (Impact Factor: 1.63). 10/2011; 32(10):925-32. DOI: 10.3113/FAI.2011.0925
Source: PubMed

ABSTRACT Obesity is a growing problem in Europe and the United States. While obesity has been linked to poor outcomes after total knee or hip replacement, there are no data addressing outcomes in obese patients who underwent total ankle replacement (TAR).
This retrospective chart review included 118 patients (123 ankles) with a minimum body mass index (BMI) of 30 kg/m2 who underwent TAR between May 2000 and June 2008. There were 61 male (51.7%) and 57 female (48.3%) patients with a mean age of 59.8 +/- 11.6 years (range, 25.4 to 85.0). All patients were evaluated pre- and postoperatively (mean followup 67.7 +/- 27.0 months; range, 29 to 126). Radiological outcomes were assessed using standardized weightbearing radiographs. Clinical outcomes were assessed using the visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale.
There were nine intraoperative complications. All patients experienced significant pain relief (VAS change from 7.0 +/- 1.7 to 1.4 +/- 1.1, p < 0.001) and functional improvement (AOFAS score change from 35.4 +/- 14.9 to 75.4 +/- 9.6, p < 0.001; total ROM change from 26.9 +/- 13.7 to 35.3 +/- 8.1 degrees, p < 0.001). BMI measured preoperatively, and at 1 and 2 years postoperatively was 32.9 +/- 2.5 (range, 30.0 to 40.0) kg/m2, 32.4 +/- 2.4 (range, 28.6 to 41.0) kg/m2, and 32.2 +/- 2.4 (range, 28.6 to 40.5) kg/m2, respectively. Gender had a significant effect on weight loss, but not age or postoperative sports activity. Revision surgery was performed in six patients, resulting in a 6-year survivorship of 93%.
Our findings confirm that TAR gives significant pain relief and functional improvement. In this study, the survivorship of the prosthesis components was comparable to the results obtained in non-obese patients.

  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this prospective study was to determine whether the more frequently quoted procedure and patient specific risk factors have any impact in the implementation of venous thromboembolism (VTE) prophylaxis following foot and ankle surgery. Two hundred and sixteen patients were included in the study. A variety of operative procedures was carried out with the common denominator being a below knee cast for at least 4 weeks and nonweightbearing for an average of 6 weeks in 130 patients. The remainder of the patients (88) had hallux surgery not requiring a cast and were allowed to weightbear. No patient received any form of thromboprophylaxis postoperatively. All patients were subjected to compression ultrasonography for deep vein thrombosis (DVT) between 2 and 6 weeks postoperatively. There was a 5.09% incidence of VTE (0.9% pulmonary embolism) overall. As no VTE (neither DVT nor pulmonary embolus) developed in the hallux subgroup, i.e. patients not requiring immobilization and were allowed to weightbear, the incidence of VTE in the cast/nonweightbearing group was 8.46%. The results are descriptive and only statistically analyzed where possible, as the sample size of the VTE group was small. There was no significant difference in number of risk factors and no association between gender in the VTE and non VTE groups. 90.9% of patients in the VTE group had a total risk factor score of 5 or more and 73.7% of patients in the non VTE group had a total risk factor score of 5 or more. The average timing to the diagnosis of VTE in this current study was 33.1 days. In view of the unacceptable incidence of VTE and the average total risk factor score of 5 or more (for which thromboprophylaxis is recommended) in the majority of the patients, the authors feel that the routine use of thromboprophylaxis in foot and ankle surgery requiring nonweightbearing in combination with short leg cast immobilization, is warranted. This prophylaxis should continue until the patient regains adequate mobility either by weightbearing (in or out of the cast) or removal of cast immobilization (weightbearing or nonweightbearing), usually between 28 and 42 days.
    Foot and Ankle Surgery 06/2014; 20(2):85-9.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: End-stage ankle arthritis is a painful and functionally limiting condition that can significantly worsen quality of life. Ankle arthrodesis, a common surgical procedure for ankle arthritis, provides good pain relief, patient satisfaction, and clinical outcomes when fusion is achieved. Potential disadvantages include malunion and nonunion, malalignment, limited range of motion (ROM), altered gait mechanics, and development of adjacent joint arthritis requiring reoperation.
    American journal of orthopedics (Belle Mead, N.J.) 10/2014; 43(10):451-7.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Obesity, one of the most common health conditions, affects an ever-increasing percentage of orthopaedic patients. Obesity is also associated with other medical conditions, including diabetes, cardiovascular disease, pulmonary disease, metabolic syndrome, and obstructive sleep apnea. These comorbidities require specific preoperative and postoperative measures to improve outcomes in this patient population. Patients who are obese are at risk for increased perioperative complications; however, orthopaedic procedures may still offer notable pain relief and improved quality of life.
    The Journal of the American Academy of Orthopaedic Surgeons 11/2014; 22(11):683-690. · 2.40 Impact Factor


Available from
Nov 5, 2014