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End-stage ankle osteoarthritis: arthroplasty offers better quality of life than arthrodesis with similar complication and re-operation rates—an updated meta-analysis of comparative studies

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Abstract

Purpose

Ankle arthrodesis (AA) has traditionally been the surgical standard for patients with an end-stage ankle osteoarthritis, with total ankle arthroplasty (TAA) recently becoming an alternative. The aim of this study was to update evidence in terms of functional outcomes, complications, and quality of life between AA and TAA by analyzing comparative studies.

Methods

PubMed, MEDLINE, Scopus, and Cochrane Central databases were used to search keywords. A total of 21 studies entered our qualitative and quantitative analysis. Demographics, functional outcomes, and complications were extracted. Random and fixed-effect models were used for the meta-analysis of standardized mean differences (SMDs) and odds ratios (ORs).

Results

A total of 18,448 patients were identified, with a mean age of 57.3 ± 11.3 years. TAA showed significantly greater post-operative range of motion (SMD − 0.883, 95% CI − 1.175 to − 0.590; I2 < 0.001) and Ankle Osteoarthritis Scale scores (SMD − 1.648, 95% CI − 3.177 to − 0.118; I2 = 97.67), but no differences in other patient-reported outcome scores were found. Patients undergoing TAA showed higher post-operative SF-36 (SMD − 0.960, 95% CI − 1.584 to − 0.336; I2 = 68.77). The total complication rate was similar between the two procedures (OR 0.936, 95% CI 0.826 to 1.060; I2 = 87.44), including the incidence of re-operations (OR 1.720, 95% CI 0.892 to 3.316; I2 = 77.65).

Conclusion

While TAA and AA showed no differences in most post-operative functional outcomes, our review demonstrates that patients undergoing TAA show better health-related quality of life than AA. We found no evidence to suggest that TAA carries a higher risk of complications and re-operations compared to AA.

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Data availability

All data generated or analyzed during this study are included in this manuscript and its Supplementary Information file.

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Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine, Woodend Hospital, Eday Road, Aberdeen, UK

    Daniele Fanelli

  2. Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, “Magna Græcia” University, V.le Europa, 88100, Catanzaro, Italy

    Michele Mercurio, Davide Castioni, Valentina Sanzo, Giorgio Gasparini & Olimpio Galasso

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  1. Daniele Fanelli
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  2. Michele Mercurio
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  3. Davide Castioni
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  4. Valentina Sanzo
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Contributions

Each author fulfils each of the authorship requirements.

D. Fanelli participated in the interpretation of data, performed the statistical analysis, and drafted the manuscript.

M. Mercurio participated in the design of the study, and in the acquisition and interpretation of data and drafted the manuscript.

D. Castioni participated in the design of the study, and in the acquisition and interpretation of data and drafted the manuscript.

V. Sanzo participated in the acquisition of data.

G. Gasparini conceived the study and approved the final version of the manuscript as submitted.

O. Galasso conceived and coordinated the study and revised critically the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Michele Mercurio.

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Fanelli, D., Mercurio, M., Castioni, D. et al. End-stage ankle osteoarthritis: arthroplasty offers better quality of life than arthrodesis with similar complication and re-operation rates—an updated meta-analysis of comparative studies. International Orthopaedics (SICOT) 45, 2177–2191 (2021). https://doi.org/10.1007/s00264-021-05053-x

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