A New ‘Approach’ to Reduce Wound Complications Following Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Despite advancements with instrumentation and implant design, total ankle arthroplasty (TAA) is still associated with a high rate of wound complications, which can lead to poorer outcomes. The aim of this study was to evaluate all wound complications following TAA and to determine any demographic or operative associations. Methods: A retrospective review of 660 consecutive TAAs was performed between November 2001 and May 2017. Data was collected on wound complications and potential risk variables, including age, sex, body-mass index, diabetes, smoking, and inflammatory arthritis. All wounds were seen at the clinic by the surgical team and a wound specialist nurse who independently recorded any issues. Major wound complications were those that required consultation with plastic surgeons, debridement by the nurse specialist, use of negative pressure therapy, or return to the operating room. All major complications were treated initially with oral antibiotics. Minor wound complications included any mention of discoloration, swelling, or clinical concern that merited the patient returning for further review. Minor wound complications were not treated with oral antibiotics. Operative notes were also reviewed to collect data on the surgical approach and additional incisions. Results: Fifty-nine patients (8.9%) had wound healing issues: 19 major (2.9%) and 40 minor (6.1%). All issues became evident <21 days postoperatively. Major wound complications were associated with a history of inflammatory arthritis, smoking, or coronary heart disease. Four patients were treated with negative pressure therapy, four with debridement in the operating room, and two were eventually converted to fusions. Fourteen (83%) patients with major complications had an ancillary procedure to balance the TAA through a separate incision. From 2001 to 2010, the standard surgical approach for TAA was performed anteriorly. All TAA patients with major wound complications were operated via an anterior surgical approach as their primary incision. No major wound complications were reported among the 22 anteromedial approaches. Conclusion: Potential TAA patients with a history of smoking, heart disease, or inflammatory arthritis should be considered with caution. A multidisciplinary team is valuable for evaluating wounds, as the majority of wound complications can be managed in the outpatient clinic with debridement, bespoke dressings, or negative pressure therapy from a specialist nurse. The anteromedial approach (see attached figure), which we have previously described, has great potential for patients who have a higher risk of developing a wound complication. Further investigation is necessary to evaluate its role in reducing the incidence of wound complications.