Comparing the Results of Total Ankle Arthroplasty Vs Tibio-talar Fusion (Ankle Arthrodesis) in Patients with Ankle Osteoarthritis since 2006- A Systematic Review



1 University of Oxford NHS Foundation Trust. Nuffield Orthopaedic Centre, Windmill Rd, Oxford, OX3 7LD, UK

2 University of Oxford NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK

3 Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Ave, Redhill RH1 5RH, UK

4 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom, OX3 7LD, UK

5 Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain


Background: This study compares the outcomes of patients undergoing total ankle arthroplasty (TAA) and tibiotalar 
fusion (ankle arthrodesis) in patients with end-stage osteoarthritis. The primary outcome assessed was Patient 
Reported Outcome Measures (PROMS); secondary outcomes included the incidence of revision, re-operation, and 
Methods: A systematic review of studies examining the outcomes of patients undergoing TAA and/or tibiotalar fusion 
from 2006 to 2020 was conducted. Individual cohort studies and randomized control trials were included. Outcomes 
were assessed at two and five years.
Results: 21 studies were included: 16 arthroplasty (2,016 patients) and 5 arthrodesis (256 patients) studies. No 
significant difference in PROMS was evident two years post-surgery – American Orthopaedic Foot and Ankle Society 
(AOFAS) scores were 78.8 (95% CI-confidence interval: 76.6-80.8; n=1548) and 80.8 (95% CI: 80.1-81.5; n=206 
patients) for the arthroplasty and arthrodesis groups respectively. Two years post-surgery the revision rates for the 
arthroplasty and arthrodesis groups were similar – 3.5% (n=9) and 3.7% (n=61) respectively (OR-odds ratio: 1.05; 95% 
CI: 0.51-2.13); however, the re-operation rate was 2.5 times higher for the arthroplasty group (12.2%) in comparison to 
the arthrodesis group (5.1%) (OR: 2.57; 95% CI: 1.43-4.62). Documented complications in the arthroplasty group were 
half those documented in the arthrodesis group two years post-surgery (OR: 0.53; 95% CI: 0.37-0.77). No arthrodesis 
studies were found which contained mean 5-year follow-up data within the study period.
Conclusion: Despite recent developments in TAA design, we found no clear evidence as to their superiority over ankle 
arthrodesis when considering patient outcomes two years postoperatively. However, this conclusion could be debatable 
in some types of patients such as diabetic patients, posttraumatic patients and patients with stiff hindfoot and midfoot.
Level of Evidence: III


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