TARVA

Total ankle replacement versus ankle arthrodesis for patients aged 50-85 years with end-stage ankle osteoarthritis: the TARVA RCT.

Goldberg AJ, Chowdhury K, Bordea E, et al. Health technology assessment (Winchester, England) 2023 · PMID 37022932 · doi:10.3310/ptyj1146

Question

In end-stage ankle arthritis, does total ankle replacement give better patient-reported function than ankle arthrodesis?

Design

Pragmatic multicentre RCT in UK NHS centres (NIHR-funded).

Patients

Adults aged 50 to 85 with end-stage ankle osteoarthritis suitable for either procedure.

Intervention

Total ankle replacement (fixed- or mobile-bearing)

Comparison

Ankle arthrodesis (open or arthroscopic)

Primary outcome

Manchester-Oxford Foot Questionnaire (MOXFQ) walking/standing domain at 52 weeks

Key result

Both groups improved substantially, with no statistically significant difference in the primary outcome at 52 weeks between replacement and arthrodesis.

Limitations

One-year primary follow-up is short for implant survival and adjacent joint degeneration; surgeons and patients were not blinded.

Impact on practice

Both procedures are reasonable for end-stage ankle arthritis; decision-making should be shared and individualised rather than assuming replacement gives better function.