Complications after total ankle arthroplasty– A systematic review

Abstract

Background: Total ankle arthroplasty was developed as an alternative option to ankle arthrodesis in patients with end-stage ankle osteoarthritis. Multiple trials have assessed the outcomes of ankle arthroplasty, but complication risk or relative effectiveness is not systematized in literature. Aim: Review complications of new designs of total ankle arthroplasty and the relationship between their severity and failure rates. Methods: We reviewed complications and revision rates of prospective studies of primary total ankle arthroplasty that included more than 50 patients and with minimum 2 years follow-up. Results: We included 22 studies (4412 ankles, median age of 61.9 years) with an adjusted mean follow-up time of 66.6 ± 40.9 months. The adjusted mean complication rate was 23.7 % (2.4–52 %), mostly high-grade complications (35.6 %). We found a statistically significant positive correlation between high- and medium-grade complications and revision rates. Conclusion: Patient selection is crucial to successfully treat end-stage ankle osteoarthritis. Further multicenter clinical trials with consistent reporting of complications are warranted.