The TARVA trial is the first multicenter RCT comparing total ankle replacement (TAR) to ankle fusion (AF) for end-stage ankle osteoarthritis. Conducted across 17 UK NHS centers, it enrolled 303 patients aged 50–85 and used the MOXFQ walking/standing domain as the primary outcome at 52 weeks. The trial asks: which operation produces superior functional outcomes and a better complication profile?
No RCT had previously compared TAR and ankle fusion head-to-head — surgical choice was guided by surgeon preference, registry data, and non-randomized cohorts that could not control for selection bias.
This trial establishes that both operations are defensible choices with equivalent primary outcomes at one year. When counseling patients, the conversation should pivot to risk profile: warn TAR patients about wound complications (13%) and nerve injury (4%), and warn fusion patients about symptomatic nonunion (7%) and the higher DVT/PE burden driven by prolonged immobilization.
When a fixed-bearing implant is available and the patient has MRI-confirmed adjacent-joint arthritis, emerging data from this trial's post hoc analysis suggest TAR may be the stronger choice. That subgroup showed a 31.5-point functional advantage, far exceeding the MCID.
One critical caveat the authors flag: these are 52-week results only. Long-term durability data, cost-effectiveness analysis, and implant survival curves are still needed before drawing definitive conclusions about which procedure wins over a decade.
The TARVA trial is the first multicenter RCT comparing total ankle replacement (TAR) to ankle fusion (AF) for end-stage ankle osteoarthritis. Conducted across 17 UK NHS centers, it enrolled 303 patients aged 50–85 and used the MOXFQ walking/standing domain as the primary outcome at 52 weeks. The trial asks: which operation produces superior functional outcomes and a better complication profile?
No RCT had previously compared TAR and ankle fusion head-to-head — surgical choice was guided by surgeon preference, registry data, and non-randomized cohorts that could not control for selection bias.
This trial establishes that both operations are defensible choices with equivalent primary outcomes at one year. When counseling patients, the conversation should pivot to risk profile: warn TAR patients about wound complications (13%) and nerve injury (4%), and warn fusion patients about symptomatic nonunion (7%) and the higher DVT/PE burden driven by prolonged immobilization.
When a fixed-bearing implant is available and the patient has MRI-confirmed adjacent-joint arthritis, emerging data from this trial's post hoc analysis suggest TAR may be the stronger choice. That subgroup showed a 31.5-point functional advantage, far exceeding the MCID.
One critical caveat the authors flag: these are 52-week results only. Long-term durability data, cost-effectiveness analysis, and implant survival curves are still needed before drawing definitive conclusions about which procedure wins over a decade.