Anterior Ankle Incision Wound Complications between Total Ankle Replacement and Ankle Arthrodesis: A Matched Cohort Study

Abstract The anterior incision is commonly used for total ankle replacement (TAR) and ankle arthrodesis. Historically, the anterior incision has demonstrated a high incidence of complications. The purpose of this study was to evaluate anterior incisional healing and soft tissue complications between total ankle replacement and ankle arthrodesis with anterior plate fixation. This was an IRB-approved retrospective review of wound healing and other complications among 304 patients who underwent primary total ankle replacement (191 patients) or ankle arthrodesis (113 patients) via the anterior approach over a four year period. The operative approach, intraoperative soft tissue handling, and postoperative protocol for the first 30 days were the same between groups. The mean follow-up was 11.8 months. To diminish the effect of selection bias, a subgroup analysis was performed comparing 91 total ankle replacement patients matched to an equal number of demographically similar ankle arthrodesis patients. Overall, 19.7% of patients experienced delayed wound healing greater than 30 days. Although the total ankle replacement and arthrodesis subgroups had dissimilar demographics, there was no difference in outcomes. Between matched pairs, no statistically significant differences were observed; however, trends were identified with matched cohort groups when compared to the overall patient series. These trends toward statistically significant differences in delayed wound healing and incidence of wound care in the matched cohort groups warrants further investigation in larger series or multi-center study. Further work is needed to identify the modifiable risk factors associated with the anterior ankle incision.