JAAOS - 2026-07-15 - Journal Article; Review; Comparative Study
Failure Rate of Fixed Versus Mobile Bearing Total Ankle Arthroplasty.
Nadeau E, Ottofaro T, Morningstar J, Gross CE, Scott DJ
Topics
Key Takeaway
Fixed bearing TAA demonstrated statistically significantly higher metal component survival rates versus mobile bearing TAA across pooled data (n=7,952), with 15-year survival of 72.0% overall, though revision rates did not differ significantly between bearing types.
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Summary
This systematic review of PubMed, CINAHL, and Scopus (2004–2024) compared survivorship of third- and fourth-generation fixed versus mobile bearing TAA implants across 85 patient groups with minimum 2-year mean follow-up. Pooled survival was 98.05%, 96.96%, 92.54%, 81.9%, and 72.0% at 1, 2, 5, 10, and 15 years respectively. Fixed bearing implants showed statistically superior metal component survival even after controlling for the substantially shorter mean follow-up in the fixed bearing cohort (3.88 vs. 6.28 years), yet no significant difference in revision rates was detected between groups.
Key Limitation
The critical limitation is the substantially longer mean follow-up in the mobile bearing cohort (6.28 vs. 3.88 years), which, despite statistical adjustment, introduces survivorship bias that may artificially inflate mobile bearing failure rates and cannot be fully corrected without individual patient-level data.
Original Abstract
BACKGROUND
With an increasing number of total ankle arthroplasties (TAAs) being performed and an abundance of new survivorship data available, an updated literature review is needed to better understand the impact of different types of implants on outcomes of TAA. This study aims to review existing literature and identify trends among current individual fixed versus mobile bearing TAA implants.
METHODS
A comprehensive search of PubMed, CINAHL, and Scopus for all articles published between 2004 and 2024 examining outcomes of third- and fourth-generation TAAs was conducted with a minimum 2-year mean follow-up. Eighty-five clearly defined implant-receiving patient groups met inclusion criteria. Forty-four groups (4,805 subjects; 60.4%) were implanted with mobile bearing devices and 41 (3,147 subjects; 39.6%) with fixed bearing implants. In total, 7,952 subjects were included, with a pooled mean age of 62.1 years and a mean BMI of 28.6 kg/m 2 .
RESULTS
Pooled mean implant survival rates were 98.05%, 96.96%, 92.54%, 81.9%, and 72.0% at 1, 2, 5, 10, and 15 years, respectively. Survival rates were statistically significantly better for fixed bearing TAAs compared with mobile bearing TAAs, even when controlling for length of follow-up (fixed: mean average follow-up = 3.88 years; range average follow-up = 2 to 7.1) (mobile: mean average follow-up = 6.28 years; range average follow-up = 2 to 15.7). No statistically significant differences were noted in revision surgery rates.
CONCLUSION
This study offers updated literature reviews of current third- and fourth-generation TAA, finding higher metal component survival rates for fixed bearing TAAs compared with mobile bearings, even when controlling for duration of follow-up. While more research is needed to confirm these findings, surgeons should be aware of these data when selecting TAA implants.
LEVEL OF EVIDENCE
Level IV, Systematic Review of Level I-IV Studies.