Outcomes after Total Ankle Arthroplasty with A Minimum Average Follow-Up of 10 Years: A Systematic Review and Meta-Analysis

Abstract

Category: Ankle Arthritis Introduction/Purpose: End-stage ankle osteoarthritis (OA) is a debilitating condition that adversely affects quality of life and causes considerable functional impairment. Total ankle arthroplasty (TAA) is growing in popularity as a motion-preserving option for ankle OA. A previously published meta-analysis evaluated the mid-term outcomes of TAA with a minimum average follow-up of 5 years, demonstrating excellent survivorship. To our knowledge, there is no such manuscript that evaluates the outcomes of TAA at the long-term, with a minimum follow-up of ten years or greater. Due to a lack of long-term follow-up of TAA implants in the current literature, the aim of this review was to aggregate findings from the most up-to-date analyses of the long-term outcomes of TAA via meta-analysis. Methods: We conducted a systematic review and meta-analysis according to the PRISMA guidelines. Electronic databases were searched from the date of inception to September 12, 2022. These databases included Medline, Embase, and Scopus. We included all studies that 1) involved patients that underwent uncemented TAA, and 2) all patients who had an average follow-up period of at least ten years. We excluded abstracts, as well as manuscripts written in languages other than English. We collected American Orthopaedic Foot and Ankle Score (AOFAS) and Visual Analog Scale (VAS) scores from the included studies for pooled meta- analysis. Due to the varying definition of survivability between studies, this metric was not assessed in our final evaluation. Results: Our data included a total of 2,562 patients and 2,895 ankles with an average follow-up of 10 years. Of the 25 studies included in the systematic review, 7 provided pre- and post-operative AOFAS means and 5 provided pre- and post-operative VAS means with associated measures of variability and were included in our meta-analysis. The weighted mean difference between pre- and post-operative AOFAS scores was -41.98 (95% CI: -48.28 to -35.69) (Fig. 1A), indicating that patients improved by almost 42 points between pre-and post-surgery. The weighted mean difference between pre-and postoperative VAS scores was 4.52 (95% CI: 2.26-6.43) (Fig. 1B), indicating patients improved by about 4.5 points on average between pre-and post-surgery. Survivability was not assessed due to the heterogeneity in survivability definition between studies. Conclusion: Outcomes following TAA are favorable and indicate patient-reported outcomes improve over long-term follow-up. Future, prospective, randomized research should be conducted to better assess TAA, and authors should work towards standardization of survivorship and complication reporting methodologies to allow for pooled metanalysis of these important outcome metrics.