The effect of COVID-19 surgical delays in total ankle arthroplasty – words of cautions

M. Dean, M. Barrett, H. Taylor

Introduction: Preoperative imaging is imperative in planning total ankle arthroplasty(TAR) procedures. COVID-19 has had a detrimental effect on waiting-lists. We assesses the consequences on our patients, and the ramifications to the planned procedure.

Methods: All patients waiting TAR attended for clinical review and radiological assessment (radiographs and if required computed tomography (e.g. to asses cyst)). Objective assessment of radiographs was performed on original and repeat imaging by measuring: Kellgren-Lawrence grading, tibiotalar tilt and ratio, cyst size and bone loss.

Results: 16 patients awaiting primary TAR were reviewed.  The median age was 72 (33-84) years, with 3 females and 13 males. The pathology was osteoarthritis(11), post traumatic(4), and haemophyllia(1). Re-assessment was undertaken at a mean of 357 (216-478) days. The modal Kelgren-Lawrence score was 3b, and did not progress. Angular deformity was present in 14 patients(6 varus, 8 valgus), there was no significant progression in angular deformity. The tibiotalar ratio changed by >5% in 4 cases demonstrating progression of anterior/posterior subluxation. Five had either progression of cysts, or bone loss significant enough to warrant further investigation with CT imaging. Of these 2 required a changes to the operative plan, due to progression of bone cysts and bone loss requiring non-standard implants.

Conclusions: 2 of our 16 patients(12.5%) required a change in operative plan due to the progression of periarticular cysts. These changes require planning, and specialist equipment and are not something one can deal with on the day of surgery. No patients in our series progressed to the stage where TAR was not possible. This study demonstrates the importance of reimaging patients who have to wait a prolonged time for surgery. The COVID crisis continues and waiting times for surgery continue to rise. All units involved in TAR need to consider this and ensure adequate re-assessment of patients prior to surgery.