Comparison of Factors Influencing Postoperative Outcomes Between Total Ankle Arthroplasty and Ankle Arthrodesis in End-stage Ankle Arthritis.

Abstract

Total ankle arthroplasty (TAA) and ankle arthrodesis (AAD) are the established surgical options for end-stage ankle arthritis. Although TAA preserve ankle motion, AAD has been the gold standard for several decades. We aimed to compare the postoperative clinical outcomes and identify factors associated with functional recovery in both procedures. We retrospectively analyzed data from 38 patients who underwent TAA (n=18) or AAD (n=20) between 2015 and 2023. Patients with a minimum of 1-year follow-up were included in this study. Preoperative and postoperative evaluations included the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and ankle range of motion (ROM) measured on lateral radiographs. Comparisons between groups were made using non-parametric tests. Both groups showed significant postoperative improvements in the JSSF scores (p<0.001). The TAA group showed no significant change in ROM (p=0.093), whereas the AAD group showed a significant decrease in ROM (p=0.011). Intraoperative blood loss and postoperative ROM differed significantly between the groups. In the TAA group, postoperative JSSF scores correlated with age, and postoperative ROM correlated with preoperative ROM. In the AAD group, postoperative JSSF scores correlated with preoperative JSSF score and postoperative ROM. Both TAA and AAD yielded favorable outcomes. The JSSF score following TAA was associated with age, whereas outcomes after AAD were more closely linked to the preoperative clinical status and postoperative ROM, highlighting the importance of adjacent joint mobility after surgery. The timing of surgery and rehabilitation strategies are essential for optimizing results.