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Complication Rates and Functional Outcomes After Total Ankle Arthroplasty in Patients with Rheumatoid Arthritis.

Colleen M Wixted¹, Albert T Anastasio², Billy I Kim¹

¹Duke University School of Medicine, Durham, North Carolina.

The Journal of Bone and Joint Surgery. American Volume

|April 25, 2025

Summary

Patients with rheumatoid arthritis (RA) undergoing total ankle arthroplasty (TAA) reported worse outcomes but still showed improvement. This study compared RA, osteoarthritis (OA), and posttraumatic arthritis patients undergoing TAA.

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Area of Science:

Orthopedic Surgery
Rheumatology
Biostatistics

Background:

Conflicting data exist on rheumatoid arthritis (RA) patients undergoing total ankle arthroplasty (TAA) compared to osteoarthritis (OA) and posttraumatic arthritis (PTA) patients.
Complications and patient-reported outcomes (PROs) require further comparative analysis.

Purpose of the Study:

To compare complication rates and PROs among patients with RA, primary OA, or PTA undergoing TAA.
To evaluate the functional outcomes and implant survival in these patient groups.

Main Methods:

Retrospective study of 1,071 primary TAAs (OA: n=372, PTA: n=642, RA: n=57) from March 2000 to October 2020.
Minimum 2-year follow-up, comparing demographics, complications, and PROs using univariable statistics and Cox regression for implant failure.
Included Short Musculoskeletal Function Assessment (SMFA), SF-36, and Foot and Ankle Outcome Score (FAOS).

Main Results:

RA cohort had lower mean age, fewer males, and higher ASA scores than OA and PTA groups.
No significant difference in infection rates; RA cohort showed higher heterotopic ossification (3.5%).
RA cohort reported worse postoperative PROs (SMFA, SF-36, FAOS) but demonstrated significant improvement from baseline; no increased risk of implant failure.

Conclusions:

In the largest single-institution study, RA patients undergoing TAA reported poorer PRO scores compared to OA and PTA groups.
Despite worse scores, RA patients experienced functional outcome improvement from their preoperative baseline after TAA.