Patients Outcomes Are Better with TAA than with Ankle Arthrodesis, Study Finds

    For patients with severe arthritis of the ankle, total ankle arthroplasty (TAA) provides better function at 4 years postoperatively than ankle arthrodesis (AA), according to a study published in The Journal of Bone & Joint Surgery.

    “Both established treatments for end-stage ankle arthritis are effective at pain relief and improved patient-reported outcomes,” according to researchers at the University of Washington and VA Puget Sound Health Care System. “However, it appears TAA leads to greater improvement in most patient-reported outcome measures at 48 months after surgery.”

    End-stage ankle arthritis is characterized by complete loss of cartilage and bone-on-bone contact in the ankle joint, with patients experiencing pain and stiffness. The standard treatment for end-stage ankle arthritis is arthrodesis, but in recent years, TAA has become a popular alternative. Questions have remained, however, as to the results of TAA versus AA, especially in the long term.

    The researchers compared outcomes in 517 patients with end-stage ankle arthritis who underwent the 2 procedures at 6 medical centers. Patients were treated according to their preferred procedure, with 414 undergoing TAA and 103 undergoing AA. All operations were performed by orthopaedic surgeons with extensive experience with each procedure.

    At 4 years postoperatively, patients in both treatment groups showed improvements in key outcomes. By most measures, results were better for patients undergoing TAA compared with those undergoing AA, including patient-reported ankle function for activities of daily living and sports, as well as physical aspects of quality of life.

    Through the first 3 years postoperatively, pain scores were also better in the TAA group. For example, average pain score (on a 0-to-10 scale) decreased from 6.3 to 1.9 in the TAA group versus 6.0 to 2.5 in the AA group. For both treatments, the improvements observed at 2 years postoperatively were maintained through 4 years postoperatively.

    Seventy-eight percent of patients who underwent TAA were “completely satisfied” with the results of their surgery, compared with 60% of those who underwent AA. Patients who underwent TAA also had a lower rate of revision surgery: 8.7% versus 17.5%.

    Although the study was designed as a randomized trial with a patient preference arm, too few patients were willing to be randomized, and the trial was converted to a prospective cohort study. The researchers controlled for the effects of potential selection bias in their analysis by evaluating and adjusting for unevenly distributed patient characteristics between treatment groups.

    The findings are “highly relevant” to patients and surgeons during the planning stage when treating severe ankle arthritis, the researchers said. They plan to perform further analyses to report the rates and risk factors for revision surgery for the 2 procedures with a longer follow-up period.


    Sangeorzan BJ, Ledoux WR, Shofer JB, et al. Comparing 4-year changes in patient-reported outcomes following ankle arthroplasty and arthrodesis. J Bone Joint Surg Am. 2021 May 19;103(10):869-878. doi: 10.2106/JBJS.20.01357.