This systematic review of 20 studies and 2,386 total ankle arthroplasties proposes the first evidence-based complication classification for TAA. Complications are stratified into three severity grades based on their likelihood of causing implant failure, not their frequency of occurrence. The framework is designed to standardize complication reporting and guide postoperative management.
Before this classification, TAA complication reporting was inconsistent across studies — there was no agreed framework for stratifying severity, making comparison across institutions and implant designs nearly impossible.
When you see a postoperative TAA patient with a wound healing problem or an intraoperative fracture noted in the operative report, recognize these as low-grade: they did not lead to failure in any reviewed study.
When you see signs of deep infection or aseptic loosening after TAA, act urgently — these are high-grade complications with failure rates above 70%, and expectant management is not appropriate.
The key teaching from Glazebrook is that rarity does not equal safety, and frequency does not equal danger. Deep infection is rare but almost always fatal to the implant. Intraoperative fracture is common but almost never is. This classification is the TAA analog to general surgery's Clavien-Dindo system — the standard framework for complication reporting in ankle replacement literature.
This systematic review of 20 studies and 2,386 total ankle arthroplasties proposes the first evidence-based complication classification for TAA. Complications are stratified into three severity grades based on their likelihood of causing implant failure, not their frequency of occurrence. The framework is designed to standardize complication reporting and guide postoperative management.
Before this classification, TAA complication reporting was inconsistent across studies — there was no agreed framework for stratifying severity, making comparison across institutions and implant designs nearly impossible.
When you see a postoperative TAA patient with a wound healing problem or an intraoperative fracture noted in the operative report, recognize these as low-grade: they did not lead to failure in any reviewed study.
When you see signs of deep infection or aseptic loosening after TAA, act urgently — these are high-grade complications with failure rates above 70%, and expectant management is not appropriate.
The key teaching from Glazebrook is that rarity does not equal safety, and frequency does not equal danger. Deep infection is rare but almost always fatal to the implant. Intraoperative fracture is common but almost never is. This classification is the TAA analog to general surgery's Clavien-Dindo system — the standard framework for complication reporting in ankle replacement literature.