Diabetes More Than Doubles the Risk of Major Limb Amputation Following Total Ankle Arthroplasty: A National Database Study with Verified Continued Patient Enrollment

Category: Ankle, Ankle Arthritis Keywords: Total Ankle Arthroplasty, Ankle Replacement, Diabetes Introduction/Purpose: Total ankle arthroplasty (TAA) is a motion-preserving alternative to ankle arthrodesis for end-stage ankle arthritis, but catastrophic complications such as lower extremity amputation may occur. Existing data are derived largely from small series, and the influence of patient comorbidities remains unclear. Methods: We performed a retrospective cohort study using the PearlDiver national claims database (2010– 2023). Patients undergoing primary TAA were stratified by diabetes status and continuous enrollment for at least five years. Subsequent below-knee amputation and above-knee amputation were identified by procedure codes. Incidence rates were calculated, Kaplan–Meier curves were used to estimate amputation-free survival, and Fisher’s exact test was used to compare amputation proportions. Results: A total of 6,439 patients underwent primary TAA, of which 2,134 (33.2%) had diabetes. Over 5 years, 39 major amputations occurred (0.60%): 37 below-knee and 2 above-knee. Patients with diabetes had a significantly higher risk of amputation than those without diabetes (0.98% vs 0.42%, relative risk 2.35, 95% CI 1.20–4.47, p = 0.0095). Kaplan–Meier analysis demonstrated a 5-year amputation-free survival rate of 99.4%. Amputation after TAA was rare (<1% at 5 years). However, patients with diabetes demonstrated a higher risk compared to non-diabetic individuals. Conclusion: Amputation after TAA is rare but occurs in roughly 1 out of 100 patients with diabetes within 5 years after undergoing the procedure, a rate more than double the non-diabetic population. These findings provide evidence for preoperative counseling and emphasize the importance of optimizing comorbidities in patients undergoing TAA.