Fate of revision total ankle arthroplasty: a meta-analysis of 999 cases

Background: Revision total ankle arthroplasty (reTAA) is becoming more common. This meta-analysis aimed to evaluate its re-revision rate and factors affecting longevity. Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guideline, we searched PubMed, Embase, Web of Science, and Cochrane Library databases from 1 January 2010 to 1 October 2024. Studies reporting survivorship of reTAA were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). The primary outcome was the re-revision rate. Pooled estimates with 95% confidence intervals (CIs) were calculated using a random-effects model. The annual re-revision rate was introduced for time-adjusted analysis. Heterogeneity was explored using meta-regression and subgroup analyses. Results: The analysis included 22 retrospective studies (cohort studies and case series) and one prospective cohort study. The NOS scores indicated moderate to high quality. A total of 999 reTAAs with a mean follow-up of five years were identified. The pooled re-revision rate was 9.9% (95% CI: 5.9% to 13.9%). The annual re-revision rate was 2.6% (95% CI: 1.8% to 3.6%). Subgroup analysis indicated that stemmed tibial components were potentially associated with a lower re-revision rate (5.5%) versus unstemmed tibial components (13.2%) (P = 0.077). However, meta-regression model identified follow-up duration as the only significant factor influencing re-revision rates. The pooled complication rate following reTAA was 18.2%. Among those failed reTAAs, 64.9% underwent conversion to ankle fusion and 5.3% received below-knee amputation. Conclusion: Although most included studies were low-level evidence, our meta-analysis revealed an overall re-revision rate of 9.9% at five-year follow-up, with an annual rate of 2.6% for reTAA. Limited evidence suggested that revision systems using stemmed tibial components might reduce the risk of re-revision.