The Pendulum Is Swinging Total Ankle (TAA) vs. Ankle Arthrodesis (AA)

by Vince Vacketta, DPM

AA has long been regarded as the gold standard procedure for end-stage ankle arthritis (ESAA). But in 2025, with significant advancements in TAA, it’s worth asking: does that consensus still hold?

Head-to-head review

A recent systematic review titled Clinical Outcomes and Safety Profile for Total Ankle Arthroplasty and Ankle Arthrodesis for Symptomatic Ankle Arthritis set out to answer that question. The study analyzed comparative data from multiple sources, focusing on clinical outcomes, complication rates, and the frequency of revision or reoperation between AA and TAA.

What the data shows

The findings were striking. TAA was associated with significantly fewer complications across several key metrics:

• Total complications were markedly lower: 13.1% for TAA vs. 31.4% for AA

• Implant removal occurred less frequently: 8.5% vs. 20%

• Adjacent level fusion was reduced: 5.1% vs. 13.4%

• Nonunion or open reduction and internal fixation was rare: 1.6% vs. 7.2%

Interestingly, no notable differences were found on patient-reported outcomes.

Shifting perspectives

Taken together, these results suggest that TAA offers a safer post-operative profile, with fewer complications and lower revision rates when compared to AA. In my view, it also brings the added benefit of earlier weightbearing and faster recovery, translating to reduced debilitation, lower fall risk, and earlier return to activities of daily life. While AA will always have a place in ESAA surgery, the expanding role of TAA reflects a broader evolution as the field advances.