Outcomes and associated factors of revision procedures after failed total ankle arthroplasty: a comparative cohort analysis

INTRODUCTION: After failed total ankle arthroplasty (TAA), revision arthrodesis (RAA) and revision arthroplasty (RTAA) are treatment options, but comparative outcome data remain limited. The aim of this study was to compare mid-term survival of RAA and RTAA after failed primary TAA and to explore clinical and radiographic factors associated with failure. MATERIALS AND METHODS: In this retrospective cohort study, 124 patients (RAA = 72, RTAA = 52) were reviewed after failed TAA between 2006 and 2020, with a minimum follow-up of 12 months. Kaplan-Meier analysis and Cox regression were used to assess survival, and decision tree models were used as exploratory tools to identify factors associated with failure. RESULTS: Mean follow-up was 71.6 ± 42.7 months. Surgical failure occurred in 6.45% of patients, with no significant difference (RAA 6.9%, RTAA 5.8%). Five-year survival was slightly higher for RTAA (97% vs. 93%), although durability decreased beyond 87 months. Female sex, higher BMI, and younger age were associated with failure after RAA, whereas large periprosthetic cysts and elevated BMI were related to failure after RTAA. CONCLUSIONS: RAA and RTAA demonstrate comparable mid-term survival after failed TAA. Revision strategy selection should be individualized, considering bone stock, patient characteristics, and failure patterns. LEVELS OF EVIDENCE: III.