The Learning Curve Associated with Revision Total Ankle Replacement

Abstract

As the frequency in which foot and ankle surgeons are performing primary total ankle replacement (TAR) continues to build, revision TAR will likely become more commonplace, creating a need for an established benchmark by which to evaluate the safety of revision TAR as determined by the incidence of complications. In this chapter, we will review the surgeon learning curve and how it may apply to revision TAR with respect to the incidence of complications. Furthermore, we will investigate the incidence of complications encountered during the surgeon learning curve period for primary TAR as reported in the world literature and will use this as a comparison by which to judge the safety of revision TAR when performed by a surgeon in their learning curve. According to data compiled by the authors, the incidence of complications associated with primary implantation of the Agility™ Total Ankle Replacement System during the surgeon learning curve is roughly 60 %. Based on both a case series of our patient data and a review of the literature, revision of these specific TAR systems during the surgeon learning period can be accomplished safely and with a lower incidence of complications, when performed meticulously by a qualified foot and ankle surgeon. Lastly, a validated classification system for complications encountered during TAR regardless of prosthetic design is needed to allow for more standardized reporting of complications, irrespective of whether they are primary or revision TAR.