Total Ankle Arthroplasty Is Safer Than Total Hip and Knee Arthroplasty in the Early Postoperative Period

J Am Acad Orthop Surg. 2020 Aug 15;28(16):671-677. doi: 10.5435/JAAOS-D-19-00205.


Background: Total hip and knee arthroplasty (THA and TKA) are performed more commonly than total ankle arthroplasty (TAA), so patients and the orthopaedic community are more familiar with the likelihood of complications after THA and TKA than after TAA. The present study places early complication rates after TAA in the context of those after THA and TKA.

Methods: Patients who underwent TAA, THA, or TKA during 2006 to 2016 as part of the National Surgical Quality Improvement Program were identified. Multivariate regression was used to compare procedures with adjustment for baseline and anesthesia characteristics.

Results: One hundred thirty-eight thousand three hundred twenty-five patients underwent THA, 223,587 TKA, and 839 TAA. The total complication rate was lower for TAA (2.98%) compared with THA (4.92%, P = 0.011) and TKA (4.56%, P = 0.049). Similarly, the rate of blood transfusion was lower for TAA (0.48%) compared with THA (9.66%) and TKA (6.44%, P < 0.001 for each). The rate of additional surgery was lower for TAA compared with THA (0.48% versus 1.79%, P = 0.007). Finally, the rate of readmission was lower for TAA (1.45%) compared with THA (3.66%, P = 0.002) and TKA (3.40%, P = 0.005).

Discussion: Patients can be counseled that relative to THA and TKA, TAA is safer in the perioperative period, with lower rates of adverse events, blood transfusion, additional surgery, and hospital readmission.

Publication types

  • Comparative Study

MeSH terms

  • Aged, 80 and over
  • Arthroplasty, Replacement, Ankle* / adverse effects
  • Arthroplasty, Replacement, Hip* / adverse effects
  • Arthroplasty, Replacement, Knee* / adverse effects
  • Blood Transfusion / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Readmission / statistics & numerical data
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Period
  • Reoperation / statistics & numerical data
  • Safety