Total Ankle Replacement (TAR) in Obese Patients

by Vince Vacketta, DPM

A patient asks: “Doctor, my ankle hurts too much to exercise and lose weight. Can we fix it first? Then I can lose weight.”

The study

Researchers conducted a retrospective cohort study examining TAR outcomes in obese patients with a minimum ten-year follow-up period. They compared results between obese patients and non-obese control groups, stratified by body mass index. Because surgical techniques and implant designs evolved during the study period, the analysis accounted for this variability. 

Key findings

Implant survivorship in obese patients proved comparable to non-obese patients, with no clear increase in revision risks. Functionally, obese patients experienced significant and sustained improvements in pain and functional scores over the long term. 

Regarding complications, obese patients showed a slight increase in wound problems. However, the study found no consistent elevation in deep infections, implant loosening, or catastrophic failure.

Notably, obesity did not drive increased subsidence or loosening rates.

Final thoughts

These findings suggest that obesity alone should not disqualify patients from TAR surgery. The procedure does not significantly compromise long-term outcomes and good survivorship and functional outcomes at ten years or longer.

Although the authors used various implants designs, they did not analyze survivorship by specific implant type. Future research may reveal whether a specific implant or design proves superior for the obese undergoing TAR.