Perioperative Complications of a Modular Stem Fixed-bearing Total Ankle Replacement with Intramedullary Guidance

Despite improved total ankle replacement outcomes, investigators have demonstrated that the incidence of complications after total ankle replacement is a function of the surgeon's experience with the technique. We hypothesized that the use of an intramedullary guide during a modular stem fixed-bearing total ankle replacement would decrease the incidence of perioperative complications and produce a similar incidence of complications across time. Because all patients were mobilized early, we also evaluated the influence of early mobilization on wound development. The medical records were reviewed to identify complications, and the radiographs were evaluated to determine the component alignment of the initial 58 consecutive ankles. Major wound complications were defined as complications requiring soft tissue coverage by a plastic surgeon. Minor wound complications were defined as those that could be treated without a return to the operating room. The procedures were separated into 2 groups: the initial 29 procedures (group A) and latter 29 procedures (group B). Eight ankles (14%) had wound complications. The incidence of complications was similar across time [r(s) (56) - -0.06, p - .64]. The incidence of complications and component misalignment was similar for groups A and B (p >= .19). All wounds were diagnosed within 15 days of surgery. None of the ankles developed wounds after physical therapy began. These results have demonstrated that the modular stem fixed-bearing total ankle replacement with intramedullary guidance can produce a similar incidence of complications over time, regardless of surgeon experience. Additionally, early mobilization did not appear to influence the incidence of wound complications and should be advocated, when appropriate. (C) 2013 by the American College of Foot and Ankle Surgeons. All rights reserved.