Persistent postoperative radiographic edema as a prognostic marker associated with wound complications and revision risk following anterior approach total ankle arthroplasty: A retrospective review.

Abstract

Total ankle arthroplasty (TAA) preserves motion in end-stage ankle osteoarthritis but remains prone to wound and implant-related complications. Due to a limited anterior soft-tissue envelope, postoperative edema may compromise perfusion and wound integrity. Although radiographic soft-tissue thickness has been explored for soft-tissue risk, the postoperative relationship between persistent edema and complications is unclear. A retrospective review at a single institution. A cohort of 50 primary TAA cases from 2021-2024 with ≥1-year follow-up was evaluated. Soft-tissue width at the talar dome was measured on weightbearing anteroposterior (AP) and lateral radiographs at four intervals: preoperative, first weightbearing (4-6 weeks), 6 months, and 1 year. Edema change (Δ) was defined as follow-up minus preoperative width. Associations between Δ and postoperative wound, revision, or explant complications were evaluated using Mann-Whitney U and Fisher's exact tests with relative risk (RR) estimation. The cohort (52% female; mean age 62.2 years; BMI 28.8 kg/m²). Four patients (8%) developed complications (two revisions, one wound, and one explant). Persistent lateral view edema at 6 months was associated with complications, regardless of them occurring from early wound complications or later implant complications, before and after 6 months, respectively (median Δ +12.3 mm vs +2.0 mm; p = 0.006; AUC 0.89). A conservative threshold of Δ≥10 mm conferred a fivefold higher risk (p = 0.016). AP-view changes were not predictive. Persistent lateral view edema at 6 months after TAA is associated with prior wound and risk of complications or revision. While post-operative edema typically returned to the pre-operative level approximately 1 year. The clinical implications of these findings suggest that early evaluation with MRI, CT, or SPECT CT following wound or implant complications can guide possible early medical or surgical intervention.