Perioperative Complications of Outpatient Total Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is commonly pursued for patients with painful arthritis. As the number of TAA increases, so too will the associated economic burden. In the current healthcare environment, savings are in the national spotlight. Studies of total joint arthroplasty (THA and TKA) have demonstrated that outpatient surgery decreases surgical costs.1,2 Additionally, outpatient THA and TKA have not been associated with increased complication or readmission rates.3–6 Outpatient TAA are becoming more common which may lead to decreased costs of care. Despite the potential savings, TAA remains an “inpatient-only procedure” for Medicare patients. Currently, there are no clinical studies examining the safety of outpatient TAA. In this study, we retrospectively reviewed 65 consecutive outpatient TAA to identify complication rates and patient risk factors. Methods: The medical records of 65 consecutive outpatient TAA from October 2012 to May 2016 with a minimum of 6-month follow-up were reviewed. All patients received popliteal and saphenous blocks with bupivacaine and epinephrine prior to surgery and were managed with oral NSAID and narcotic pain medication post-operatively. All patients received a STAR total ankle prosthesis. Demographics, comorbidities, ASA and perioperative complications including wound breakdown, infection, revision and non-revision surgeries were compared to historic controls. Mean follow up was 16.6 +/- 9.1 months (range, 6-42 months). Results: The overall complication rate in this series was 21.8%. One ankle (1.5%) had a wound breakdown requiring debridement and flap coverage. This patient had a history of Polycythemia Vera with re-thrombosis of their popliteal artery one month after TAA surgery. Two ankles (3%) had deep infections. Nine ankles (13.8%) required non-revision surgery. Three ankles (4.6%) required posterior capsular release, one ankle (1.5%) required medial malleolar screws for symptomatic stress reaction, and three ankles (4.6%) required arthroscopic or open gutter release. Two ankles (3%) required revision surgery. One for talar component subsidence in a patient with Charcot-Marie-Tooth managed with an arthrodesis at eleven months. The other revision was performed for aseptic tibial component loosening and managed with conversion to an INBONE prosthesis at seven months. Conclusion: This study demonstrates the safety of outpatient TAA. The combination of regional anesthesia and oral narcotics provided a satisfactory outpatient experience and zero patients required readmission for pain control. The one wound complication (1.5%) was attributed to arterial occlusion and not outpatient management. This compares to the 6.6-28% wound breakdown rate found in the literature.7–10 Our revision surgery rate (3%) was comparable to the 3.1-16.5% rate found in the literature, and was also not attributed to outpatient management.7–10 We feel this demonstrates that outpatient TAA can be performed safely