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. 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/m2. 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. 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 IV, Systematic Review of Level I-IV Studies.
Nadeau et al. (2025) studied this question.