Total ankle arthroplasty incision management: What Matters? A systematic review

Modern advancements in total ankle arthroplasty techniques and implants have increased their popularity as treatment for ankle osteoarthritis. The preeminent approach for ankle replacement involves an anterior incision. However, wound complications with this approach provide a persistent challenge to surgeons. The present study was conducted to synthesize current data on ankle replacement wound complications via an anterior approach. A systematic review was completed including studies published from 1993 to present that employed an anterior approach and had precise criteria for wound healing and revisions. Twenty-nine studies, with level 3 to 4 evidence and moderate to serious bias, were included for a total of 6,986 ankle arthroplasties. The rate of wound healing without any complication was 90.38 %. Minor dehiscence occurred in 6.00 % of cases, while major wounds or infections occurred in 3.62 %. Across 2,966 implants, the rate of major wounds or infections decreased from 7.03 % before 2013 to 4.75 % after 2013 (p = 0.034). Limited comparisons involving simple suture closure to various adjunct wound management techniques including negative pressure wound therapy, 2-octyl cyanoacrylate, platelet-rich plasma, dehydrated human amniotic membrane allograft, non-invasive skin expansion strips, compression wound dressings, tranexamic acid, surgical helmets, tourniquets, ankle arthrodesis, and lateral approach ankle arthroplasty, yielded non-significant differences (p > 0.18). Therefore, contemporary techniques, patient selection, and current implants may be leading to better soft tissue healing. As ankle replacement continues to surge in popularity, further research is needed to evaluate causative factors in successful anterior incision healing.

Level of Clinical Evidence

3