Clinical outcomes and feasibility of a fast-track protocol after total ankle replacement: a prospective study

Postoperative recovery after total ankle replacement remains challenging, and evidence supporting the use of fast-track protocols in this setting is limited. The purpose of this study was to evaluate the short-term clinical outcomes and safety of a fast-track protocol following total ankle replacement.

A prospective observational study was conducted on consecutive adult patients undergoing primary total ankle replacement through an anterior approach between January 2023 and June 2024. All procedures were performed by a single experienced surgeon using the same implant. The fast-track protocol included early postoperative mobilization, multimodal pain management, bleeding control, and structured physiotherapy with standardized discharge criteria. Ankle function was assessed using the American Orthopaedic Foot and Ankle Society's (AOFAS) Ankle Hindfoot Scale preoperatively and at hospital discharge. Secondary outcomes included time to active ankle mobilization, time to assisted ambulation with crutches, length of hospital stay, and wound healing evaluated using the ASEPSIS wound score.

Twenty-two patients were included. Median AOFAS Ankle Hindfoot Scale scores improved significantly from 29.0 preoperatively to 68.0 at discharge. Active ankle mobilization was achieved after a median of two days, assisted ambulation after three days, and the median hospital stay was five days. Wound healing outcomes were favourable, with low ASEPSIS scores and only one minor wound complication managed conservatively. No major wound complications, infections, or prosthesis-related adverse events were observed.

In this prospective single-arm study, a fast-track protocol following total ankle replacement was feasible and was associated with early functional recovery and favourable short-term safety outcomes. These findings should be interpreted as preliminary and descriptive, given the absence of a control group. Larger comparative studies with longer follow-up are needed to determine its effectiveness relative to conventional postoperative care.