Total Ankle Arthroplasty Outcome in Patients with Inflammatory vs Non-Inflammatory Arthritis: Systematic Review and Meta-Analysis

CATEGORY: Ankle; Ankle Arthritis INTRODUCTION/PURPOSE: The decision regarding total ankle replacement is challenging in inflammatory arthritis patients regarding more inferior bone quality, large bone cysts, and increased risk for infections. This systematic review aimed to compare the short and long-term results of total ankle replacement, including the revision rate and the patient-reported outcomes between inflammatory rheumatoid arthritis (RA) versus non-inflammatory ankle osteoarthritis (OA). METHODS: All published clinical studies on total ankle arthroplasty were searched in the databases. We extracted the data, specifically the American Orthopaedic Foot & Ankle Society (AOFAS) improvement, complication rate, and the reoperation rate. The results were also analyzed based on the prosthesis type. RESULTS: In total, 34 trials were included in our study. Out of 5,078 patients, the underlying condition was rheumatoid arthritis in 1,327 patients and was non-inflammatory osteoarthritis in 2,849 patients. There was statistically significant higher AOFAS improvement in the patients with RA vs. OA with a mean follow-up of 63 months (P=0.009). The rates of TAA removal or revision were estimated at 16% (95% CI, 10%-23%) in the OA and 13% (95% CI, 9%-18%) in the RA group. Overlapping confidence intervals showed no significant difference in the rate of failure between RA and OA. The survival rate was 66% in the OA group and 88% in the RA group during a 63-month follow-up. CONCLUSION: Total ankle replacement is a safe procedure in RA patients with fewer minor and major complications relative to other reasons for ankle osteoarthritis.