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Scientific Articles   |    
Risk Factors for Incision-Healing Complications Following Total Ankle Arthroplasty
Steven M. Raikin, MD1; Justin Kane, BS2; Michael E. Ciminiello, MD2
1 Orthopaedic Foot and Ankle Service, Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107. E-mail address: steven.raikin@rothmaninstitute.com
2 Department of Orthopaedic Surgery, Thomas Jefferson University Medical College, 1015 Walnut Street, Philadelphia, PA 19107
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Sep 15;92(12):2150-2155. doi: 10.2106/JBJS.I.00870
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Abstract

Background: 

The anterior incision used for the insertion of total ankle arthroplasty systems is at high risk for wound complications, and little has been documented regarding who is at risk for the development of these complications.

Methods: 

We conducted a retrospective chart review of 106 total ankle arthroplasties. Independent risk variables, including age, sex, body-mass index, diabetes, smoking, medications, preoperative diagnosis, implant size, tourniquet time, closure method, and anticoagulation status, were recorded. Postoperative office notes were reviewed for wound-related complications. Outcomes were divided into three categories: no complications (uncomplicated wound-healing), minor complications (wounds requiring only local care/oral antibiotics), and major complications (requiring a return to the operating room for treatment). Simultaneously, categorical variables were compared with use of chi-square analysis. Multivariate logistic regression and odds ratio assessment were performed as well.

Results: 

When patients who had no complications were compared with those who had minor complications, a history of diabetes was the only variable that was identified as resulting in a significant risk increase (p = 0.04). When patients who had no wound complications or minor wound complications were compared with those who had major wound complications, female sex, a history of corticosteroid use, and underlying inflammatory arthritis were all associated with increased risk. Multivariate logistic regression demonstrated underlying inflammatory arthritis (p = 0.004) to be the only significant risk factor for major wound complications, with an odds ratio demonstrating a 14.03 times increased risk of requiring reoperation.

Conclusions: 

We recommend that caution be used when selecting and educating patients with inflammatory arthritic conditions who are potential candidates for total ankle arthroplasty.

Level of Evidence: 

Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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