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Review
. 2025 Sep 5;17(9):e91680.
doi: 10.7759/cureus.91680. eCollection 2025 Sep.

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

Tarik Al-Dahan  1 , Sebastian Ndlovu  1 , Baljinder Dhinsa  1 , Crispin Southgate  1 , Darren Geoffrey  1 , Chiranjit De  1 , Sathya Lakpriya  1 , Nabil Seoudi  1 , Rusul Al Bairmani  2
Affiliations
Review

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

Tarik Al-Dahan et al. Cureus. .

Abstract

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.

Keywords: ankle arthritis; outcomes; post traumatic arthritis; total ankle arthroplasty; total ankle replacement.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flow diagram.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses. *Counts per database before deduplication. **Excluded at title/abstract screening.
Figure 2
Figure 2. Forest plot comparing revision rates between non-traumatic arthritis (POA) versus post-traumatic osteoarthritis (PTOA) following total ankle arthroplasty.
Figure 3
Figure 3. Forest plot comparing postoperative AOFAS scores between non-traumatic arthritis (POA) and post-traumatic osteoarthritis (PTOA) after total ankle arthroplasty.
Figure 4
Figure 4. Forest plot of mean change in AOFAS scores from preoperative to postoperative period following total ankle arthroplasty.
Figure 5
Figure 5. Forest plot comparing overall complication rates between non-traumatic (POA) and post-traumatic osteoarthritis (PTOA) following total ankle arthroplasty
Figure 6
Figure 6. Forest plot comparing malleolar fracture rates between non-traumatic arthritis (POA) and post-traumatic osteoarthritis (PTOA) following total ankle arthroplasty.
Figure 7
Figure 7. Forest plot of overall complication rates following total ankle arthroplasty.
Figure 8
Figure 8. Forest plot of revision rates following total ankle arthroplasty.
Figure 9
Figure 9. Forest plot of malleolar fracture rates following total ankle arthroplasty.
Figure 10
Figure 10. Forest plot of mean change in pain scores (Ankle Osteoarthritis Scale (AOS)) from preoperative to postoperative period following total ankle arthroplasty.
Figure 11
Figure 11. Forest plot of mean change in Visual Analogue Scale (VAS) pain scores from preoperative to postoperative period following total ankle arthroplasty.
Figure 12
Figure 12. Forest plot of mean change in ankle dorsiflexion range of motion from preoperative to postoperative period following total ankle arthroplasty.
Figure 13
Figure 13. Forest plot of mean change in ankle plantarflexion range of motion from preoperative to postoperative period following total ankle arthroplasty.
See this image and copyright information in PMC

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