Comparing Early Outcomes and Complications Between Total Ankle Arthroplasty and Ankle Arthrodesis In Patients With Primary Ankle Osteoarthritis: Big Data Analysis

Background: Ankle osteoarthritis (OA) significantly impairs mobility and quality of life, particularly in its end-stage. Total ankle arthroplasty (TAA) and ankle arthrodesis (AA) are pivotal interventions once conservative treatments have failed. This study compares the outcomes of TAR and AA in managing end-stage ankle OA using a large dataset to discern the most effective approach for patient-centered care. Methods: Utilizing the National Inpatient Sample (NIS), we conducted a retrospective analysis of 27,595 patients who underwent TAA or AA from 2016 to 2019. Propensity score matching was applied to address potential biases and achieve group equivalence in observational comparisons. Results: Primary OA accounted for 85.9% of TAA and 55.4% of AA procedures. The utilization of TAA increased significantly (p < 0.0001) from 73% in 2016 to 78% in 2019, while AA declined from 27% to 22% during the same period. Among 27,595 patients (20,765 TAA; 6,830 AA), TAA patients were older (65.61 vs. 59.66 years, p < 0.0001) and more frequently insured under Medicare (59.3% vs. 47.8%, p < 0.0001). Racial analysis showed a higher prevalence of Caucasian patients in the TAA group (90.1% vs. 83.5%, p < 0.0001). Patients undergoing AA exhibited a significantly higher burden of comorbidities, including type 2 diabetes (24.9% vs. 13.8%), chronic lung disease (9.5% vs. 4.5%), obesity (33.2% vs. 22.2%), and mental disorders (36.6% vs. 26.4%) (all p < 0.0001). Conclusions: TAR and AA present distinct profiles of outcomes and patient demographics. This study underscores TAR’s increasing preference and its associated lower immediate postoperative risks. However, the choice of procedure should be tailored to individual patient conditions, taking into consideration age, underlying comorbidities, and surgical risks to optimize outcomes. These findings are crucial for guiding future research and enhancing clinical decisions in the management of end-stage ankle OA.