Complications, Reoperations, and Healthcare Costs Following Total Ankle Arthroplasty vs Ankle Arthrodesis

Background: Ankle arthrodesis (AA) has historically been the gold standard surgical treatment for end-stage ankle arthritis, providing reliable pain relief at the expense of motion. Total ankle arthroplasty (TAA) has emerged as a motion-preserving alternative with improving survivorship and functional outcomes. However, large-scale comparative data evaluating complications, reoperation rates, opioid utilization, and health care costs remain limited. This study compared outcomes following AA and TAA using a national administrative database. Methods: A retrospective cohort study was performed using a national claims database. Adult patients undergoing primary TAA or AA were identified, excluding cases involving trauma, infection, or malignancy. Propensity score matching (1:1) was performed based on age, sex, year of surgery, insurance type, and comorbidities. Thirty-day complications, 2-year outcomes, postoperative opioid utilization, and cumulative health care costs were assessed. Categorical variables were compared using χ 2 testing and continuous variables using independent-samples t-tests. Results: A total of 15 898 patients met inclusion criteria (9271 AA; 6627 TAA). After matching, 6627 patients remained in each cohort. At 2 years, TAA demonstrated lower rates of any reoperation compared with AA (3.1% vs 7.7%, P < .001), driven by lower rates of revision (1.1% vs 3.3%), hardware removal (1.3% vs 5.5%), and infection-related reoperations (1.3% vs 1.9%) (all P < .05). Diagnosis-based endpoints, reported separately, similarly favored TAA. Within 30 days, TAA was associated with fewer complications (1.0% vs 2.3%, P < .001). Although index costs were modestly higher for TAA, cumulative costs at 2 years were lower ($7225 vs $8043, P < .001). Early opioid use was slightly higher following TAA but converged by 1 year. Conclusion: In a propensity-matched national cohort, TAA demonstrated lower reoperation rates, fewer early complications, and lower cumulative costs at 2 years compared with AA, supporting TAA as a durable treatment option.