2025 ISAKOS Biennial Congress ePoster
No Superiority of Transfibular Approach Compared to Direct Anterior Approach for Total Ankle Arthroplasty: A Systematic Review and Meta-analysis
James J. Butler, MB, BCh, New York, New York UNITED STATES
Ravneet Dhilion, MD, Dublin IRELAND
Akram Habibi, MD, New York, NY UNITED STATES
Andrew Rosenbaum, Albany, NY UNITED STATES
Michael Mulligan, MD, Albany, NY UNITED STATES
Raymond J. Walls, MD, FRCS(Tr&Orth), FAAOS, Staten Island, NY UNITED STATES
John G. Kennedy, MD, MCh, MMSc, FFSEM, FRCS (Orth), New York UNITED STATES
NYU Langone Health, New York, NY, UNITED STATES
FDA Status Not Applicable
Summary
This systematic review found no significant differences in clinical and radiological outcomes between the transfibular and direct anterior approaches for total ankle arthroplasty, though the findings are limited by small sample sizes and short-term follow-up, warranting further research.
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Abstract
Introduction
The purpose of this study was to compare outcomes following transfibular approach and direct anterior approach for total ankle arthroplasty (TAA).
Methods
During January 2024, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies comparing outcomes between transfibular approach and direct anterior approach for TAA for the management of ankle osteoarthritis. Data regarding study characteristics, patient demographics, subjective clinical outcomes, radiological outcomes, complications, and failure rates were extracted and analyzed. In addition, the level of evidence and quality of evidence for each individual study was also assessed. Six studies were included in this review.
Results
There were 224 patients in the transfibular cohort and 273 patients in the direct anterior approach cohort. The mean follow-up time was 4.5 ± 2.1 years. There was no statistically significant difference in AOFAS scores, FAOS scores, talar tilt, prosthesis loosening, failures, complications and secondary surgical procedure rates between the 2 cohorts (p > 0.05 for all variables).
Discussion And Conclusion
This systematic review demonstrated no difference in outcomes between transfibular approach and direct anterior approach for TAA for the management of ankle osteoarthritis. However, this study is limited by the small patient cohorts, low number of studies and short-term follow-up, thus further studies with longer follow-up are warranted.