The Use of PRP and Wound-healing Complications after Total Ankle Arthroplasty

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Authors: Costanzo, JA.  Kane, JM.  Raikin, SM.
Rothman Institute at Thomas Jefferson University Hospital Philadelphia, PA

Title: The Use of PRP and Wound-healing Complications after Total Ankle Arthroplasty

Background: Improved implant designs and surgical techniques have made total ankle arthroplasty (TAA) an increasingly reliable treatment option for symptomatic ankle arthritis.  Despite the improved outcomes over first-generation designs, incision-healing complications continue to present a significant problem in the early postoperative period.  Although there is a great quantity of literature regarding the use of platelet-rich plasma (PRP) in wound healing, most studies have been conducted retrospectively on a small number of patients and have provided conflicting results.  As such, there is no consensus on PRP’s usefulness in acute incisional healing.

Hypothesis/Purpose: Does PRP reduce wound healing complications in the post-operative period in total ankle arthroplasty.

Methods: A retrospective review of 133 consecutive TAA performed by a single surgeon at a single institution was conducted. 78 patients’ incisions were sprayed with PRP prior to and following closure, while 55 had closure without PRP application.  Analysis of preoperative characteristics showed no significant differences.  Patients were followed until they either had complete healing of their wound or had to undergo a surgical procedure to address the complication. Wound healing complications were divided into “None”; “Minor” (responded to local care); “Major” (return to operating room).

Results: The incidence of wound complications in the PRP group was 10.25% (8/78). When compared to the group who did not receive PRP (5.45%; 3/55) there was no significant difference (p=0.52; OR=1.97; CI=0.45-12.09).  The incidence of minor complications in the PRP group was 32.9% (23/70).  Compared to the incidence in the group who did not receive PRP (26.9%; 14/52) there was no significant difference (p=0.85; OR 1.09; CI 0.47-2.61). 55% (47/85) of patients who experienced no wound healing complications had received PRP.

Discussion: The foot and ankle present unique challenges in wound healing given the minimal soft tissue envelope and relatively limited vascularity.  To our knowledge, this is the first study to report the results of intraoperative topical PRP application in TAA. Our study demonstrated no difference in complications between patients receiving PRP and those undergoing traditional wound closures.

Conclusion: The application of PRP did not make a significant difference in wound healing after TAR.