Total ankle replacement versus ankle fusion for end-stage ankle osteoarthritis: a narrative review of the latest literature data (2023-2025).

This review compares the outcomes of total ankle replacement (TAR) and ankle fusion (AF) in patients with end-stage ankle osteoarthritis (OA) based on recent comparative studies (1 January 2023 to 31 December 2025). Racial/ethnic, socioeconomic, and payer status disparities have been reported in the likelihood of experiencing TAR versus AF for ankle OA. A prospective multicentre study with level II evidence found that the long-term clinical results of TAR and AF were similar. A meta-analysis identified TAR as the superior intervention, demonstrating significant advantages in patient-reported outcome measures. Three systematic reviews have reached the following conclusions: i) postoperative outcomes are similar in TAR and AF; ii) TAR and AF have similar complication rates (both minor and major); iii) both TAR and AF are safe and effective surgical treatments for ankle OA; besides, TAR had notable lower total complications, implant removals, adjacent level fusion surgeries, and non-union/open reduction and internal fixation surgeries after the index procedure. The existence of mixed evidence found in the literature makes it necessary to select the surgical technique to be used (TAR or AF) on an individual basis. To definitively determine which procedure is more appropriate in advanced ankle OA, more and better-designed studies are required, given that the results reported thus far do not permit to determine with absolute certainty which of the two procedures, TAR or AF, is more adequate.