Total ankle arthroplasty versus ankle arthrodesis in end-stage osteoarthritis: A meta-analysis of comparative outcomes.

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The treatments for end-stage ankle arthritis are challenging. Standard treatment methods include ankle arthrodesis (AA) and total ankle arthroplasty (TAA). This meta-analysis compares the outcomes of TAA and AA based on comparative studies. Literature databases include PubMed, Embase, and Google Scholar. Keywords related to the treatment of end-stage ankle osteoarthritis with AA compared to TAA were used. The outcome measurements include functional outcomes and revision rates. Review Manager 5.4 was used to conduct statistical analysis. A standard p-value of <0.05 indicated statistical significance. 27 comparison articles, including data from 12,341 patients, were included in the meta-analysis. 4917 patients underwent total ankle arthroplasty, while 7440 underwent ankle arthrodesis. The results showed a significant difference in the AOFAS score favoring TAA (p < 0.001). Dorsiflexion range of motion (ROM) also showed a significant difference in favor of TAA (p < 0.001). Additionally, the TAA group's plantarflexion ROM was significantly superior (p < 0.001). The overall SF-36 score, which measures quality of life, reported improved outcomes for patients who underwent TAA compared to those with AA (p < 0.001). The Activities of Daily Living, calculated by the Foot and Ankle Ability Measure (FAAM) score, also showed significant improvement in patients who had TAA compared to those who received AA (p < 0.001). When both the Activities of Daily Living and Sports subscales were combined, there was a significant improvement in the total FAAM score for TAA patients (p < 0.001). However, there was a significant difference in revision rates favoring AA (p < 0.001). This meta-analysis compared postoperative outcomes of ankle arthrodesis (AA) and total ankle arthroplasty (TAA) through patient-reported and functional measures. By synthesizing qualitative and quantitative data, we identified TAA as the superior intervention, demonstrating significant advantages in AOFAS scores, FAAM activities of daily living, FAAM total scores, SF-36 total scores, and range of motion. These findings aid in tailoring surgical decisions for end-stage ankle osteoarthritis, particularly when patient-specific factors such as anatomical suitability, comorbidities, or access to advanced care limit treatment options. Additionally, this study supports the recent trend of showing comparable revision rates between TAA and AA.

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