Risk factors for failure of primary total ankle replacement

Total ankle arthroplasty is becoming an increasingly popular alternative to arthrodesis for the treatment of end-stage tibiotalar arthritis. As our indications evolve due to new advancements in our current generation of total ankle implants and improvements in surgical technique, we must continually seek to understand what factors place a patient at risk for a suboptimal outcome. In this chapter, we examine the evidence-based risk factors for failures and poor outcomes following total ankle arthroplasty. We reviewed the literature which ranges from smaller single-institution reports to large-scale registry data. Currently, evidence exists that smoking, depression, diabetes, and ipsilateral hindfoot arthrodesis may be risk factors for poorer outcomes and increased complications while preoperative deformity and a history of previous ankle infection do not seem to increase complications. The long-term effect of obesity is unknown, and while young age does not appear to affect clinical outcomes, the long-term revision risk may be increased. Overall, more studies are needed to further evaluate these and other potential risk factors for failure of total ankle arthroplasty as prospective level 1 studies with large numbers of patients are lacking in the literature. As we move forward toward greater acceptance of the procedure, we must continually re-evaluate our indications and risk factors in order to risk stratify patients and optimize outcomes.