Comparison of anterior and lateral approaches for total ankle replacement: a retrospective Cohort study.

Abstract

Total ankle replacement can be performed through a direct anterior approach or a lateral transfibular approach, but comparative evidence on perioperative burden and reoperation patterns remains limited. To compare reoperation burden and perioperative outcomes between the direct anterior and lateral transfibular approaches for primary total ankle replacement. Retrospective cohort study. Consecutive primary total ankle replacements performed at a single center between January 2016 and December 2021 were reviewed. Outcomes included reoperations, intraoperative and postoperative complications, operative time, length of hospital stay, and adjunctive procedures. Analyses were exploratory. The cohort included 188 patients (120 anterior, 68 lateral). Length of hospital stay was 3.56 ± 1.49 days after anterior procedures and 3.67 ± 1.35 days after lateral procedures (p = 0.67). Overall complication rates were 31.67% and 30.88%, respectively. Operative time was longer in the lateral group (139.00 ± 34.17 minutes) than in the anterior group (115.00 ± 26.70 minutes). Reoperations per patient were higher and more heterogeneous in the lateral group (0.730) than in the anterior group (0.096). Adjunctive procedures were common; Achilles tendon lengthening was more frequent in anterior procedures (61.67% vs 47.06%, p = 0.025). In this cohort, the two approaches showed similar early length of stay and overall complication rates. The lateral transfibular approach required longer operative time and showed a more heterogeneous reoperation burden, potentially influenced by case complexity and adjunctive procedures.