{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:36:00Z","timestamp":1791959760532,"version":"4.3.4"},"reference-count":48,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T00:00:00Z","timestamp":1703721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Hallym University Research Fund","award":["NRF-2022R1C1C1011649"],"award-info":[{"award-number":["NRF-2022R1C1C1011649"]}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT)","doi-asserted-by":"publisher","award":["NRF-2022R1C1C1011649"],"award-info":[{"award-number":["NRF-2022R1C1C1011649"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Total ankle arthroplasty (TAA) has higher complication and failure rates compared to other surgical joint replacement procedures despite technological advances. This study aimed to find the long-term survivability of the TAA procedure and identify the patient risk factors for failure with one of the largest cohorts of patients in the literature. Methods: This retrospective cohort study involving cases between 2007 and 2018 analyzed patients who received an index primary TAA procedure in Korea. A total of 5619 cases were included in the final analysis. The TAA failure was defined as either a case with revision arthroplasty or a case with TAA implant removal and arthrodesis performed after primary TAA. Results: During the study period, the 5-year survival rate was 95.4% (95% CI, 94.7\u201396.1%), and the 10-year survival rate was 91.1% (95% CI, 89.1\u201393.1%). A younger age (&lt;55 years, adjusted hazard ratio [AHR], 1.725; 55\u201364 years, AHR, 1.812; p &lt; 0.001 for both), chronic pulmonary disease (AHR, 1.476; p\u00a0= 0.013), diabetes (AHR, 1.443; p\u00a0= 0.014), and alcohol abuse (AHR, 1.524; p = 0.032) showed a significantly high odds ratio for primary TAA failure in Cox regression analysis. Conclusion: The 10-year TAA survivorship rate was 91.1%. A younger age, chronic pulmonary disease, diabetes, and heavy alcohol consumption are risk factors for TAA.<\/jats:p>","DOI":"10.3390\/jcm13010179","type":"journal-article","created":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T09:35:21Z","timestamp":1703756121000},"page":"179","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Long-Term Survival Analysis of 5619 Total Ankle Arthroplasty and Patient Risk Factors for Failure"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1354-7780","authenticated-orcid":false,"given":"Sivakumar Allur","family":"Subramanian","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5934-0665","authenticated-orcid":false,"given":"Hyong Nyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SeongHyeon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9207-8100","authenticated-orcid":false,"given":"Jihyun","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong I.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7986-6493","authenticated-orcid":false,"given":"Hye Chang","family":"Rhim","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02129, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4785-8154","authenticated-orcid":false,"given":"Sung Jae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lew","family":"Schon","sequence":"additional","affiliation":[{"name":"Center for Orthopaedic Innovation, Mercy Medical Center, Baltimore, MD 21202, USA"},{"name":"Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD 21202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Il-Hoon","family":"Sung","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hanyang University Hospital, Seoul 04763, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.2106\/JBJS.L.01234","article-title":"HINTEGRA Total Ankle Replacement: Survivorship Analysis in 684 Patients","volume":"95","author":"Barg","year":"2013","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"711","DOI":"10.2106\/JBJS.K.01580","article-title":"The Scandinavian Total Ankle Replacement: Long-Term, Eleven to Fifteen-Year, Survivorship Analysis of the Prosthesis in Seventy-Two Consecutive Patients","volume":"95","author":"Brunner","year":"2013","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/1071100715604392","article-title":"Effect of Obesity on Total Ankle Arthroplasty Outcomes","volume":"37","author":"Schipper","year":"2016","journal-title":"Foot Ankle Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1177\/1071100715606477","article-title":"The Effect of Obesity on Functional Outcomes and Complications in Total Ankle Arthroplasty","volume":"37","author":"Gross","year":"2016","journal-title":"Foot Ankle Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"659","DOI":"10.3113\/FAI.2011.0659","article-title":"Correction of Moderate to Severe Coronal Plane Deformity with the STAR Ankle Prosthesis","volume":"32","author":"Reddy","year":"2011","journal-title":"Foot Ankle Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1177\/1071100718806474","article-title":"Risk Factors for Failure of Total Ankle Arthroplasty with a Minimum Five Years of Follow-Up","volume":"40","author":"Cody","year":"2019","journal-title":"Foot Ankle Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1302\/0301-620X.97B11.33636","article-title":"Failure to Restore Sagittal Tibiotalar Alignment in Total Ankle Arthroplasty: Its Relationship to the Axis of the Tibia and the Positioning of the Talar Component","volume":"97","author":"Cho","year":"2015","journal-title":"Bone Jt. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1053\/j.jfas.2017.10.034","article-title":"Effect of Obesity on Total Ankle Arthroplasty: A Systematic Review of Postoperative Complications Requiring Surgical Revision","volume":"57","author":"Sansosti","year":"2018","journal-title":"J. Foot Ankle Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1302\/0301-620X.95B11.31633","article-title":"The Outcome of Total Ankle Replacement: A Systematic Review and Meta-Analysis","volume":"95","author":"Zaidi","year":"2013","journal-title":"Bone Jt. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1177\/1071100714555569","article-title":"Effect of Diabetes Mellitus on Perioperative Complications and Hospital Outcomes after Ankle Arthrodesis and Total Ankle Arthroplasty","volume":"36","author":"Schipper","year":"2015","journal-title":"Foot Ankle Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2150","DOI":"10.2106\/JBJS.I.00870","article-title":"Risk Factors for Incision-Healing Complications Following Total Ankle Arthroplasty","volume":"92","author":"Raikin","year":"2010","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s11999-009-0987-3","article-title":"How Successful Are Current Ankle Replacements? A Systematic Review of the Literature","volume":"468","author":"Gougoulias","year":"2010","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.2106\/JBJS.L.00538","article-title":"HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses","volume":"95","author":"Hintermann","year":"2013","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1177\/1071100718794956","article-title":"Patient-Reported Outcomes Before and After Primary and Revision Total Ankle Arthroplasty","volume":"40","author":"Lachman","year":"2019","journal-title":"Foot Ankle Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1302\/0301-620X.96B12.34364","article-title":"The Impact of Diabetes on the Short- to Mid-Term Outcome of Total Ankle Replacement","volume":"96","author":"Choi","year":"2014","journal-title":"Bone Jt. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1177\/1071100714568869","article-title":"Infected Total Ankle Arthroplasty: Risk Factors and Treatment Options","volume":"36","author":"Patton","year":"2015","journal-title":"Foot Ankle Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1177\/1071100715585575","article-title":"Impact of Diabetes on Outcome of Total Ankle Replacement","volume":"36","author":"Gross","year":"2015","journal-title":"Foot Ankle Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"199","DOI":"10.2106\/JBJS.18.00313","article-title":"The Effect of Patient Characteristics on 1 to 2-Year and Minimum 5-Year Outcomes After Total Ankle Arthroplasty","volume":"101","author":"Cunningham","year":"2019","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding Algorithms for Defining Comorbidities in ICD-9-CM and ICD-10 Administrative Data","volume":"43","author":"Quan","year":"2005","journal-title":"Med. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"771","DOI":"10.2106\/JBJS.18.00980","article-title":"Risk of Revision Following Total Knee Arthroplasty or High Tibial Osteotomy: A Nationwide Propensity-Score-Matched Study","volume":"101","author":"Yoon","year":"2019","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.2106\/JBJS.15.01060","article-title":"Five-Year Survival of 20,946 Unicondylar Knee Replacements and Patient Risk Factors for Failure: An Analysis of German Insurance Data","volume":"98","author":"Jeschke","year":"2016","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1093\/bmb\/ldn039","article-title":"History and Evolution in Total Ankle Arthroplasty","volume":"89","author":"Gougoulias","year":"2009","journal-title":"Br. Med. Bull."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1177\/107110079201300601","article-title":"Long-Term Follow-up of the Conaxial (Beck-Steffee) Total Ankle Arthroplasty","volume":"13","author":"Wynn","year":"1992","journal-title":"Foot Ankle"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.fas.2013.04.005","article-title":"A Systematic Review of Intermediate-Term Outcomes and Failure Rates for Total Ankle Replacements: An Asian Perspective","volume":"19","author":"Angthong","year":"2013","journal-title":"Foot Ankle Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1080\/17453674.2019.1709312","article-title":"Better Implant Survival with Modern Ankle Prosthetic Designs: 1,226 Total Ankle Prostheses Followed for up to 20 Years in the Swedish Ankle Registry","volume":"91","author":"Unden","year":"2020","journal-title":"Acta Orthop."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"684","DOI":"10.2106\/JBJS.21.00746","article-title":"Survivorship of 4,748 Contemporary Total Ankle Replacements from the French Discharge Records Database","volume":"104","author":"Dagneaux","year":"2022","journal-title":"J. Bone Jt. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1302\/0301-620X.101B1.BJJ-2018-0801.R1","article-title":"Survivorship and Long-Term Outcome of a Consecutive Series of 200 Scandinavian Total Ankle Replacement (STAR) Implants","volume":"101","author":"Clough","year":"2019","journal-title":"Bone Jt. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e720","DOI":"10.3928\/01477447-20120426-27","article-title":"Functional Disabilities and Issues of Concern for Asian Patients before Total Ankle Arthroplasty","volume":"35","author":"Lee","year":"2012","journal-title":"Orthopedics"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1177\/0363546505284189","article-title":"Sports and Recreation Activity of Ankle Arthritis Patients before and after Total Ankle Replacement","volume":"34","author":"Valderrabano","year":"2006","journal-title":"Am. J. Sports Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.2106\/00004623-200406000-00008","article-title":"Complications and Failure after Total Ankle Arthroplasty","volume":"86","author":"Spirt","year":"2004","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1177\/1071100715579717","article-title":"Effect of Age on Outcomes in Total Ankle Arthroplasty","volume":"36","author":"Demetracopoulos","year":"2015","journal-title":"Foot Ankle Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.fas.2016.09.005","article-title":"Functional and Clinical Outcomes of Total Ankle Arthroplasty in Elderly Compared to Younger Patients","volume":"23","author":"Tenenbaum","year":"2017","journal-title":"Foot Ankle Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1053\/j.jfas.2020.01.004","article-title":"Age-Related Outcomes in Total Ankle Arthroplasty: An Analysis of 112 Patients","volume":"59","author":"Cottom","year":"2020","journal-title":"J. Foot Ankle Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1080\/17453674.2020.1751499","article-title":"12-Year Survival Analysis of 322 Hintegra Total Ankle Arthroplasties from an Independent Center","volume":"91","author":"Zafar","year":"2020","journal-title":"Acta Orthop."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/S0140-6736(07)61380-4","article-title":"Global Burden of COPD: Risk Factors, Prevalence, and Future Trends","volume":"370","author":"Mannino","year":"2007","journal-title":"Lancet"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"E93","DOI":"10.5888\/pcd16.190035","article-title":"Chronic Obstructive Pulmonary Disease and Arthritis Among US Adults, 2016","volume":"16","author":"Liu","year":"2019","journal-title":"Prev. Chronic Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"J258","DOI":"10.1016\/j.jaut.2009.12.003","article-title":"Effects of Tobacco Smoke on Immunity, Inflammation and Autoimmunity","volume":"34","author":"Arnson","year":"2010","journal-title":"J. Autoimmun."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1177\/1071100716655435","article-title":"Association of Cigarette Use and Complication Rates and Outcomes Following Total Ankle Arthroplasty","volume":"37","author":"Lampley","year":"2016","journal-title":"Foot Ankle Int."},{"key":"ref_39","first-page":"e8","article-title":"Total Ankle Arthroplasty: A Critical Analysis Review","volume":"6","author":"Cody","year":"2018","journal-title":"J. Bone Jt. Surg. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"904","DOI":"10.2106\/JBJS.N.00837","article-title":"The Impact of Obesity on the Outcome of Total Ankle Replacement","volume":"97","author":"Bouchard","year":"2015","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1177\/1071100719849084","article-title":"Total Ankle Arthroplasty Survival and Risk Factors for Failure","volume":"40","author":"Escudero","year":"2019","journal-title":"Foot Ankle Int."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1093\/bja\/aen401","article-title":"Smoking and Alcohol Intervention before Surgery: Evidence for Best Practice","volume":"102","author":"Tonnesen","year":"2009","journal-title":"Br. J. Anaesth."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Rotevatn, T.A., Boggild, H., Olesen, C.R., Torp-Pedersen, C., Mortensen, R.N., Jensen, P.F., and Overgaard, C. (2017). Alcohol Consumption and the Risk of Postoperative Mortality and Morbidity after Primary Hip or Knee Arthroplasty\u2014A Register-Based Cohort Study. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0173083"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1097\/AOG.0b013e318297be8d","article-title":"Alcohol Use Disorders and Hospital-Acquired Infections in Women Undergoing Cesarean Delivery","volume":"122","author":"Goldberg","year":"2013","journal-title":"Obstet. Gynecol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.jse.2014.05.019","article-title":"Analysis of Perioperative Morbidity and Mortality in Shoulder Arthroplasty Patients with Preexisting Alcohol Use Disorders","volume":"24","author":"Ponce","year":"2015","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"10","DOI":"10.4070\/kcj.2012.42.1.10","article-title":"Validity of the Diagnosis of Acute Myocardial Infarction in Korean National Medical Health Insurance Claims Data: The Korean Heart Study (1)","volume":"42","author":"Kimm","year":"2012","journal-title":"Korean Circ. J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2985","DOI":"10.1007\/s00296-013-2833-x","article-title":"Development of an Algorithm for Identifying Rheumatoid Arthritis in the Korean National Health Insurance Claims Database","volume":"33","author":"Cho","year":"2013","journal-title":"Rheumatol. Int."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.fas.2018.12.003","article-title":"Positive and Negative Factors for the Treatment Outcomes Following Total Ankle Arthroplasty? A Systematic Review","volume":"26","author":"Zhao","year":"2020","journal-title":"Foot Ankle Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/1\/179\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:43:24Z","timestamp":1760132604000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/1\/179"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,28]]},"references-count":48,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["jcm13010179"],"URL":"https:\/\/doi.org\/10.3390\/jcm13010179","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,28]]}}}