--- title: "Short-term complicatons & separate incisions in TAR. | Sutter Health" description: "Study suggests that surgeons can add adjuvant procedures during TAR without affecting short-term complication rates." url: "https://www.sutterhealth.org/research/publications/short-term-complications-sep-incisions-tar-1055312445" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Short-term complicatons & separate incisions in TAR. # Association of short-term complications with procedures through separate incisions during total ankle replacement. Criswell B, Hunt K, Kim T, Chou L, & Haskell A. _Foot Ankle Int. pii: 1071100716651964. \[Epub ahead of print\]_ 2016-06-08 ## Abstract BACKGROUND: Surgeons disagree about the safety of adding adjuvant procedures requiring separate incisions during total ankle replacement (TAR). This study tested the hypothesis that complication rates for patients in the first year after TAR would be greater when combined with procedures through separate incisions. METHODS: A retrospective review was performed on a consecutive series of 124 patients who underwent total ankle replacement between 2007 and 2013. Demographics, case-specific data, and postoperative complications over the first year were collected. A chi-square analysis was performed to compare differences in complication rates among patients with and without additional procedures requiring a separate incision. The average patient age was 67±10 years. Fourteen patients (11%) were diabetic and 2 patients (2%) were current smokers. Eighty-seven (70%) had prior trauma leading to arthritis. Ninety-seven (78%) cases used the Scandinavian Total Ankle Replacement (STAR), 16 (13%) Salto Talaris, and 11 (9%) In Bone implants. Ten (8%) cases were revisions. Excluding percutaneous Achilles lengthening, 35 of 124 patients (28%) had a total of 54 adjuvant procedures requiring a separate incision during TAR. These included 9 (7%) calcaneal osteotomies, 8 (6%) medial malleolar fixation, 6 (5%) subtalar fusions, 5 (4%) lateral ligament repair, 4 (3%) open Achilles lengthening, 4 (3%) removal of hardware, 2 (2%) first metatarsal osteotomy, and 8 other procedures. RESULTS: Overall, 32 (26%) of the 124 patients had a complication, including 15 (12%) delayed wound healing, 6 (5%) malleolar fracture, and 11 other complications. At 1 year, 24 (27%) of 89 patients without additional incisions and 8 (23%) of 35 patients with additional incisions, excluding percutaneous Achilles lengthening, had any complication (P = .64). DISCUSSION: This study did not demonstrate an association between additional procedures requiring a separate incision during TAR and early complications. Overall complication rates were similar to previously reported series of TAR. This study suggests that surgeons can add adjuvant procedures during TAR to improve alignment, stability, or treat adjacent segment arthritis without affecting short-term complication rates. The necessity or utility of these adjuvant procedures requires further study. LEVEL OF EVIDENCE: Level III, comparative series. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/27283155) ![Andrew Haskell, M.D.](https://dyn.mktgcdn.com/p/e19Z0QwiEJVIawTe_Uey_VlyYexupaSsdn87lO6XoJk/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Andrew Haskell, M.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/andrew-haskell-md-1049681101) ## Research topics - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Musculoskeletal Disorders](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Musculoskeletal+Disorders%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Peritenolysis and debridement for main body (mid-portion) Achilles tendinopathy in athletic patients: results of 107 procedures.](https://www.sutterhealth.org/research/publications/peritenolysis-debridemt-achilles-tendinopathy-1055312289) Saxena A, Hong BK, Hofer D. J Foot Ankle Surg. pii: S1067-2516(17)30271-5. doi: 10.1053/j.jfas.2017.04.020. \[Epub ahead of print\] 2017 May 31 - Publication ### [Plate fixation with autogenous calcaneal dowel grafting proximal fourth and fifth metatarsal fractures: technique and case series.](https://www.sutterhealth.org/research/publications/plate-fix-autog-calcan-dowel-graft-4-5-metatar-fx-1055312444) Seidenstricker CL, Blahous EG, Bouché RT, Saxena A. J Foot Ankle Surg. pii: S1067-2516(17)30286-7. doi: 10.1053/j.jfas.2017.04.035. \[Epub ahead of print\] 2017 Jun 09 - Publication ### [Vibration and pressure wave therapy for calf strains: a proposed treatment.](https://www.sutterhealth.org/research/publications/vibration-pressure-wave-tx-calf-strains-1055312323) Saxena A, St Louis M, Fournier M. Muscles Ligaments Tendons J. 3(2):60-2. doi: 10.11138/mltj/2013.3.2.060. Print 2013 Apr. 2013 Jul 09 - Publication ### [Percutaneous plating of Weber B fibular fractures.](https://www.sutterhealth.org/research/publications/percutaneous-plate-weber-b-fibula-fx-1055312373) Saxena A, Yun A. J Foot Ankle Surg. pii: S1067-2516(16)30393-3. doi: 10.1053/j.jfas.2016.11.012. \[Epub ahead of print\] 2017 Jan 12 - Publication ### [An Internet-based risk- and stage-tailored osteoporotic fracture risk management program: Effect on knowledge, attitudes and behaviors](https://www.sutterhealth.org/research/publications/osteoporotic-fracture-risk-management-program-1055312543) Drieling RL, Ma J, Thiyagarajan S, Stafford RS. J Women's Health (Larchmt). 20(12):1895-907. doi: 10.1089/jwh.2010.2515. Epub 2011 Oct 4. 2011 Dec 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/short-term-complications-sep-incisions-tar-1055312445#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Short-term complicatons & separate incisions in TAR."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/short-term-complications-sep-incisions-tar-1055312445#medicalscholarlyarticle","name":"Association of short-term complications with procedures through separate incisions during total ankle replacement.","headline":"Short-term complicatons & separate incisions in TAR.","abstract":"BACKGROUND: Surgeons disagree about the safety of adding adjuvant procedures requiring separate incisions during total ankle replacement (TAR). This study tested the hypothesis that complication rates for patients in the first year after TAR would be greater when combined with procedures through separate incisions. METHODS: A retrospective review was performed on a consecutive series of 124 patients who underwent total ankle replacement between 2007 and 2013. Demographics, case-specific data, and postoperative complications over the first year were collected. A chi-square analysis was performed to compare differences in complication rates among patients with and without additional procedures requiring a separate incision. The average patient age was 67±10 years. Fourteen patients (11%) were diabetic and 2 patients (2%) were current smokers. Eighty-seven (70%) had prior trauma leading to arthritis. Ninety-seven (78%) cases used the Scandinavian Total Ankle Replacement (STAR), 16 (13%) Salto Talaris, and 11 (9%) In Bone implants. Ten (8%) cases were revisions. Excluding percutaneous Achilles lengthening, 35 of 124 patients (28%) had a total of 54 adjuvant procedures requiring a separate incision during TAR. These included 9 (7%) calcaneal osteotomies, 8 (6%) medial malleolar fixation, 6 (5%) subtalar fusions, 5 (4%) lateral ligament repair, 4 (3%) open Achilles lengthening, 4 (3%) removal of hardware, 2 (2%) first metatarsal osteotomy, and 8 other procedures. RESULTS: Overall, 32 (26%) of the 124 patients had a complication, including 15 (12%) delayed wound healing, 6 (5%) malleolar fracture, and 11 other complications. At 1 year, 24 (27%) of 89 patients without additional incisions and 8 (23%) of 35 patients with additional incisions, excluding percutaneous Achilles lengthening, had any complication (P = .64). DISCUSSION: This study did not demonstrate an association between additional procedures requiring a separate incision during TAR and early complications. Overall complication rates were similar to previously reported series of TAR. This study suggests that surgeons can add adjuvant procedures during TAR to improve alignment, stability, or treat adjacent segment arthritis without affecting short-term complication rates. The necessity or utility of these adjuvant procedures requires further study. 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