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Updated: May 29, 2026
Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
Comparison of anterior and lateral approaches for total ankle replacement: a retrospective Cohort study
Marco Di Ponte1, Silvio Caravelli1, Marianna Viotto1
1U.O. Ortopedia Bentivoglio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Background:
Total ankle replacement can be performed through a direct anterior approach or a lateral transfibular approach, but comparative evidence on perioperative burden and reoperation patterns remains limited.
Purpose:
To compare reoperation burden and perioperative outcomes between the direct anterior and lateral transfibular approaches for primary total ankle replacement.
Study Design:
Retrospective cohort study.
Methods:
Consecutive primary total ankle replacements performed at a single center between January 2016 and December 2021 were reviewed. Outcomes included reoperations, intraoperative and postoperative complications, operative time, length of hospital stay, and adjunctive procedures. Analyses were exploratory.
Results:
The cohort included 188 patients (120 anterior, 68 lateral). Length of hospital stay was 3.56 ± 1.49 days after anterior procedures and 3.67 ± 1.35 days after lateral procedures (p = 0.67). Overall complication rates were 31.67% and 30.88%, respectively. Operative time was longer in the lateral group (139.00 ± 34.17 minutes) than in the anterior group (115.00 ± 26.70 minutes). Reoperations per patient were higher and more heterogeneous in the lateral group (0.730) than in the anterior group (0.096). Adjunctive procedures were common; Achilles tendon lengthening was more frequent in anterior procedures (61.67% vs 47.06%, p = 0.025).
Conclusions:
In this cohort, the two approaches showed similar early length of stay and overall complication rates. The lateral transfibular approach required longer operative time and showed a more heterogeneous reoperation burden, potentially influenced by case complexity and adjunctive procedures.
