Complications of total ankle arthroplasty versus ankle arthrodesis: A systematic review and meta-analysis with trial sequential analysis

Jonathan Jia En Boey; Rui Xiang Toh; Yao Chen Loh; Chen Zhang; Ryan Ruiyang Ling; Zong Xian Li; Kizher Shajahan Mohamed Buhary; Kae Sian Tay

doi:10.1016/j.fas.2024.11.008

Complications of total ankle arthroplasty versus ankle arthrodesis: A systematic review and meta-analysis with trial sequential analysis

Foot Ankle Surg. 2024 Dec 16:S1268-7731(24)00264-9. doi: 10.1016/j.fas.2024.11.008. Online ahead of print.

Authors

Jonathan Jia En Boey¹, Rui Xiang Toh², Yao Chen Loh³, Chen Zhang³, Ryan Ruiyang Ling⁴, Zong Xian Li¹, Kizher Shajahan Mohamed Buhary¹, Kae Sian Tay¹

Affiliations

¹ Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
² Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore. Electronic address: toh.rui.xiang@singhealth.com.sg.
³ Faculty of Medicine, University of New South Wales, Sydney, Australia.
⁴ Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Australia and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Anaesthesia, National University Hospital, National University Health System, Singapore.

PMID: 39701836
DOI: 10.1016/j.fas.2024.11.008

Abstract

Background: Ankle osteoarthritis affects 1-3 % of all adults. Contemporary evidence is equivocal when comparing the outcomes and complications of TAA and AA. This review aims to compare the complications between TAA and AA to provide surgeons with an additional perspective when managing ESAO.

Methods: We conducted a systematic review and meta-analysis, searching four international databases from inception until 21 Jan 2024 for RCTs and score-matched studies reporting on TAA or AA for ESAO. Score-matched studies were included if matching accounted for four or more covariates related to patient demographics and comorbidities. Random-effects (DerSimonian and Laird) meta-analyses were conducted. The primary outcome was complications stratified into total, major, and minor as guided by previous studies. We rated intra-study risk of bias using the Cochrane Risk of Bias 2 tool and the Newcastle-Ottawa Scale. We assessed the certainty of evidence using the GRADE approach.

Results: 5 studies (2 RCTs and 3 score-matched studies) totalling 13,957 patients (6975 TAA, 6982 AA) were included in the meta-analysis. The pooled RR for total complications was 0.95 (95 %-CI: 0.85 to 1.08, p = 0.45, moderate certainty, favourable towards AA). The pooled RR for major complications was 1.18 (95 %-CI: 0.70 to 1.98; p = 0.54, low certainty, favouring TAA) and for minor complications was 0.96 (95 %-CI: 0.75 to 1.22; p = 0.73, moderate certainty, favouring AA).

Conclusion: Previous reviews have recognised TAA and AA as equivocally effective surgical options for patients with ESAO. Our review may suggest that TAA and AA have similar rates of major and minor complications. Surgeons should consider the specific complications for TAA and AA despite the similar rates of complications when counselling patients.

Protocol registration: CRD42023389626.

Keywords: Ankle; Ankle arthrodesis; Complications; End-stage ankle osteoarthritis; Total ankle arthroplasty.

Publication types

Review