How does total ankle arthroplasty affect fall risk?: A nationwide database study of 130,982 older adults with ankle...

Falls are now the leading cause of injury-related deaths in the US among older adults. While foot/ankle pain, osteoarthritis and limited ankle joint range of motion serve as independent risk factors for falls in older adults, it is uncertain whether surgical correction of ankle osteoarthritis via total ankle arthroplasty (TAA) can mitigate this risk. In this retrospective cohort study, we examined US adults aged 50 and over who underwent TAA from January 2010 to April 2022 using commercial, state, and federal claims data obtained via PearlDiver, Inc. The surgery group was compared to a similar sample of older adults who were treated nonoperatively for foot and ankle osteoarthritis over the same time frame. Cox proportional hazards regression models were utilized to examine the association of surgery and an injurious fall while controlling for important covariates. In the first year of follow-up, a greater proportion of people fell in the non-surgery group (31%, 41,049/130,318) than in the surgery group (27%, 177/664) (chi-square p<0.01). Furthermore, patients who underwent TAA were 51% less likely (adjusted HR 0.491, 95%CI 0.381 to 0.634) to fall over the 11+ year follow-up compared to those living with foot and ankle osteoarthritis without TAA. Our findings suggest TAA is safe in older adults, and that ankle osteoarthritis may be a surgically modifiable risk factor for falls.