This 2007 systematic review pooled outcomes from 49 studies comparing total ankle arthroplasty and ankle arthrodesis. It is the first meta-analytic comparison of the two procedures, covering 852 TAA and 1262 arthrodesis patients. All TAA data reflect second-generation implants at approximately 5-year mean follow-up.
A patient with end-stage ankle arthritis asks you which procedure is safer. This paper gives you the numbers: TAA and arthrodesis achieve nearly identical functional scores, but arthrodesis carries a 5% amputation rate versus 1% after TAA.
That amputation gap is the key counseling point. When a patient asks about long-term limb risk, especially one with rheumatoid arthritis or limited salvage options, TAA's lower amputation burden is a real argument for arthroplasty over fusion.
Be careful about applying these numbers universally. The TAA cohort here was older (mean 58 years), predominantly female, and predominantly rheumatoid. The arthrodesis cohort was younger (mean 50 years), mostly male, and mostly posttraumatic. These are different patients — the equivalence in scores does not mean the procedures are interchangeable across all comers.
One nuance worth knowing: TAA's 5-year and 10-year survival rates are nearly identical (78% vs 77%), which implies most failures happen early. If a TAA implant makes it past the first few years, long-term survival looks reasonably stable.
This 2007 systematic review pooled outcomes from 49 studies comparing total ankle arthroplasty and ankle arthrodesis. It is the first meta-analytic comparison of the two procedures, covering 852 TAA and 1262 arthrodesis patients. All TAA data reflect second-generation implants at approximately 5-year mean follow-up.
A patient with end-stage ankle arthritis asks you which procedure is safer. This paper gives you the numbers: TAA and arthrodesis achieve nearly identical functional scores, but arthrodesis carries a 5% amputation rate versus 1% after TAA.
That amputation gap is the key counseling point. When a patient asks about long-term limb risk, especially one with rheumatoid arthritis or limited salvage options, TAA's lower amputation burden is a real argument for arthroplasty over fusion.
Be careful about applying these numbers universally. The TAA cohort here was older (mean 58 years), predominantly female, and predominantly rheumatoid. The arthrodesis cohort was younger (mean 50 years), mostly male, and mostly posttraumatic. These are different patients — the equivalence in scores does not mean the procedures are interchangeable across all comers.
One nuance worth knowing: TAA's 5-year and 10-year survival rates are nearly identical (78% vs 77%), which implies most failures happen early. If a TAA implant makes it past the first few years, long-term survival looks reasonably stable.