Clinical Outcomes and Safety Profile for Total Ankle Arthroplasty and Ankle Arthrodesis for Symptomatic Ankle Arthritis: A Systematic Review

Background: Ankle arthritis is very common in the population. Total ankle arthroplasty (TAA) and ankle arthrodesis (AA) are the most common surgical options for this pathology. The current systematic review aims to evaluate and present the most recent literature on outcomes and complications among both surgical options. Methods: Two independent authors done a systematic literature search using the following databases: PubMed, Embase, and the Cochrane library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol and the Cochrane Handbook guidelines were followed. The search criteria were based on TAA versus AA. The dates selected were 2010 to 2025. The minimum follow-up for inclusion was 12 months. The MINORS score criteria was used to evaluate the strength and quality of the nonrandomized controlled trials by two authors. Results: Nine studies were included in the review. A total of 7,443 surgeries, including 3,460 TAA and 3,983 AA, were completed. The average age for the TAA and AA groups was 63.9 and 56.7 years, respectively, and body mass index was 28.6 kg/m 2 and 30.3 kg/m 2 , respectively. The mean follow-up for the TAA and AA groups was 29.9 and 30.6 months, respectively. A statically significant lower rate for total complications (13.1% vs 31.4%), removal of implant (8.5% vs 20%), adjacent level fusion (5.1% vs 13.4%), and nonunion/open reduction and internal fixation (1.6% vs 7.2%) was found for the TAA group. No notable differences were found on patient-reported outcomes. Conclusion: Both TAA and AA are safe and effective surgical treatments for ankle arthritis. Among the data gathered in this systematic review, TAA had notable lower total complications, implant removals, adjacent level fusion surgeries, and nonunion/open reduction and internal fixation surgeries after the index procedure. It is hoped that these data help physicians plan treatment for patients with symptomatic ankle arthritis and contribute to evidence-based guidelines.