Outcomes of Total Ankle Arthroplasty in Non-traumatic Arthritis Versus Post-traumatic Arthritis: A Systematic Review and Meta-Analysis

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The objective of this review is to compare the outcomes of total ankle arthroplasty in patients with ankle arthritis without previous ankle trauma or intervention versus patients with post-traumatic arthritis. Further analysis was performed to review the outcomes of ankle arthroplasty irrespective of the patients' cohorts. A comprehensive literature search of Embase, Ovid Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ovid Emcare and Cochrane, Turning Research Into Practice (TRIP) databases. In total, 17 studies met the inclusion criteria. Continuous data were pooled using the mean difference with a 95% Confidence interval. Dichotomous data were pooled as a risk ratio with a 95% Confidence interval, both using the Inverse variance random effect model. The pooled analysis indicates a revision rate of 4.2% (14 of 330 patients) in the ankle arthritis without previous trauma or intervention group (POA) compared to 11.8% (29 of 245 patients) in the post-traumatic arthritis group (PTOA). There was no statistical difference in the American Orthopaedic Foot and Ankle Society (AOFAS) score between POA and PTOA groups (MD=1.0, 95% CI: 4.4 to 6.4) and no statistically significant difference in the complication rates between POA and PTOA (RR=0.79, 95% CI: 0.59 to 1.07). This meta-analysis demonstrates that total ankle arthroplasty in patients with prior surgical intervention for post-traumatic arthritis is associated with higher revision rates than in patients without previous intervention. However, they might still yield a similar functional outcome in the short term. The role of total ankle arthroplasty should be clearly defined, weighing risks against patient expectations, with longitudinal studies needed to further clarify such risks and benefits.

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