Fixed-Bearing Versus Mobile-Bearing Prostheses in Total Ankle Arthroplasty: A Systematic Review and Meta-Analysis

Background/Objectives: Total ankle replacement (TAR) is considered an effective solution for end-stage ankle arthritis. New-generation implants have shown promising intermediate clinical outcomes and are available in two main designs: fixed-bearing and mobile-bearing prostheses. The aims of this study are to compare both prosthetic systems, focusing on (i) the revision rate for major complications, including conversion to arthrodesis, revision of components, and below-knee amputation; (ii) minor complications requiring additional surgery; and (iii) providing a comprehensive overview of total ankle replacement. Methods: A systematic review of the literature was conducted using the main databases. The inclusion criteria were patients aged 18 years or older and individuals who had undergone total ankle arthroplasty. Case reports, case series, original articles, and systematic reviews were excluded from the final selection. The pooled incidence of events was reported using odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Results: A total of 33 studies, pooling data from 3652 observations and identifying 635 events, met the inclusion criteria. Relevant demographic and surgical data were systematically extracted and analyzed. A meta-analysis of comparable data revealed revision and failure risks for both prosthesis types. No statistically significant differences in complication rates were observed between fixed-bearing and mobile-bearing prostheses. Conclusions: Both fixed-bearing and mobile-bearing prostheses are viable options for treating ankle arthritis, demonstrating an intermediate risk of complications over short, medium, and long-term follow-ups.