Complication Rates After Total Ankle Arthroplasty for Tibiotalar Arthritis Compared to Tibiotalar Arthrodesis.

BACKGROUND: Total ankle arthroplasty (TAA) and tibiotalar arthrodesis (TTA) are primary surgical treatments for end-stage tibiotalar arthritis, but comparative short-term outcomes remain incompletely characterized. PURPOSE: To compare complications, readmission, discharge disposition, and hospital length of stay (LOS) after TAA versus TTA. STUDY DESIGN: Level III retrospective cohort study. METHODS: Adults with primary or post-traumatic tibiotalar osteoarthritis who underwent TAA or TTA from 2018 through 2024 were identified in the HCA Enterprise Database. Outcomes included surgical site infection (SSI), deep vein thrombosis (DVT), amputation, 30-day and 1-year readmission, discharge destination, and LOS. Multivariable regression evaluated independent predictors. RESULTS: A total of 1,330 patients were included: 732 underwent TAA and 598 underwent TTA. Compared with TTA, TAA had lower rates of SSI (3.1% vs 21.6%; p < 0.001), DVT (0.0% vs 0.8%; p = 0.043), amputation (0.0% vs 1.7%; p = 0.001), and 1-year readmission (4.0% vs 16.1%; p < 0.001), and higher home discharge (99.2% vs 63.0%; p < 0.001). On multivariable analysis, TAA was associated with lower odds of SSI (OR, 0.19), any complication (OR, 0.17), and 1-year readmission (OR, 0.28), greater odds of home discharge (OR, 51.4), and shorter LOS (β, -1.99 days). Higher Elixhauser Comorbidity Index increased the odds of SSI and readmission and decreased the odds of home discharge. CONCLUSIONS: TAA was associated with lower short-term morbidity, lower 1-year readmission, greater home discharge, and shorter LOS than TTA. LEVEL OF EVIDENCE: III, retrospective cohort.