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Total ankle replacement versus nonoperative management for end-stage ankle osteoarthritis: A comparative analysis.

Karolien Schwagten·Frederick Michels·Corey Scholes·Andrew Wines
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Abstract

BACKGROUND: The optimal management of end-stage ankle osteoarthritis remains debated. This study compared short-term outcomes between non-operative treatment, total ankle replacement (TAR), and cases in which indicated surgery was delayed. METHODS: In this secondary analysis of prospectively collected data, treatment survival, Foot and Ankle Outcome Score (FAOS), and patient satisfaction were assessed at baseline and at 1- and 2-year follow-up. RESULTS: In a total of 316 patients one-year treatment survival was highest for TAR (99.3%), followed by NOM (94.4%) and delayed surgery (80.9%). TAR demonstrated significantly superior FAOS pain and quality-of-life scores compared with NOM and delayed surgery. Delayed surgery was associated with significantly worse pain and quality-of-life outcomes. Patient satisfaction was highest in the TAR group and lowest in the delayed surgery group. CONCLUSIONS: TAR provides superior pain relief, quality of life, and satisfaction compared with non-operative management in end-stage ankle OA. While NOM remains a valid option for selected patients, delaying indicated surgery results in inferior outcomes, underscoring the importance of timely, shared decision-making.

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HumansArthroplasty, Replacement, AnkleOsteoarthritisFemalePatient SatisfactionQuality of LifeMiddle AgedMaleAnkle JointAgedProspective StudiesTreatment OutcomeConservative TreatmentPain MeasurementAnkleAnkle replacementNonoperative management (NOM)Prospective studyJournal ArticleComparative Study

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Karolien Schwagten, Frederick Michels, Corey Scholes, Andrew Wines. 2026-03-27. Total ankle replacement versus nonoperative management for end-stage ankle osteoarthritis: A comparative analysis.. https://doi.org/10.1016/j.fas.2026.03.010

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Journal Article; Comparative Study resourceAged subjectComparative Study subjectFemale subjectHumans subjectJournal Article subjectMale subjectMiddle Aged subjectPain Measurement subjectPatient Satisfaction subject

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