Return to Sport and Activity after Total Ankle Arthroplasty and Arthrodesis: A Systematic Review

CATEGORY: Ankle Arthritis; Ankle; Other INTRODUCTION/PURPOSE: There is no consensus regarding participation in sports and recreational activities following total ankle replacement (TAR) and ankle arthrodesis (AA). Better understanding on this topic will allow orthopaedic foot and ankle surgeons to set evidence-based goals and expectations with their patients in regards to postoperative activity recommendations and quality of life. We aimed to summarize the evidence on return to sport and activity after surgical management with either TAR or AA for ankle osteoarthritis (OA). METHODS: A literature search of PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was performed in January 2020. The bibliographies of all relevant publications were searched for further applicable studies. Included studies were required to report sport and activity outcomes in patients undergoing TAR and AA, with primary outcomes being percentage of sport participation and level of sport participation. Excluded studies were non-English and did not assess level of sport activity after TAR or AA. RESULTS: Twelve studies met inclusion criteria for analysis. There were 1,270 ankle procedures, of which 923 TAR and 347 AA were performed. Mean reported patient age was 59.2 years old and mean BMI was 28 kg/m2. Mean follow-up was 43 months. Fifty-four percent of patients were active in sports preoperatively compared to 63.7% postoperatively (Figure 1). Mean preoperative activity participation rate was 41% in the TAR cohort, but improved to 59% after TAR, whereas preoperative activity participation rate of 73% was similar to postoperative rate of 70% in the AA cohort. The most common sports in TAR and AA groups were swimming, hiking, cycling, and skiing. CONCLUSION: Participation in sports activity is nearly 10% improved after surgical management of ankle OA. The existing literature demonstrated a large improvement in pre-to postoperative activity levels after TAR, with minimal change in activity after AA, however, AA patients were more active at baseline. The most frequent postoperative sports activities after surgical management of ankle OA are: swimming, hiking, cycling, and skiing. Despite preoperative participation in high-impact sports such as tennis, soccer, and running, these were consistently limited after surgery. This review of the literature will equip patients and physicians with the knowledge to appropriately establish realistic expectations for postoperative physical activity and return to sport goals.