Comparing Early Outcomes and Complications Between Total Ankle Arthroplasty and Ankle Arthrodesis in Patients with Ankle Osteoarthritis: Big Data Analysis.

End-stage ankle osteoarthritis (OA) severely limits function and quality of life. Total ankle arthroplasty (TAA) and ankle arthrodesis (AA) are key surgical interventions when conservative treatment fails. This study compares TAA and AA outcomes using a national dataset to inform patient-centered care. A retrospective analysis of 27,595 patients undergoing TAA or AA from 2016-2019 was conducted using the National Inpatient Sample. Propensity score matching addressed baseline differences. Primary OA was more prevalent in TAA (85.9%) than in AA (55.4%). TAA utilization rose from 73% to 78% ( < 0.0001), while AA declined. TAA patients were older (65.6 vs. 59.7 years), more often Medicare-insured, and predominantly Caucasian. AA patients had higher rates of comorbidities, including diabetes, obesity, lung disease, and mental disorders (all < 0.0001). TAA and AA cater to distinct patient profiles. TAA is increasingly favored and associated with lower immediate risks, though procedure choice should be individualized based on comorbidities and risk profiles. These insights support evidence-based decision-making in end-stage ankle OA management.