OBJECTIVESTo provide a cumulative data about the complications of second or third generation ankle prostheses in the literature, and to provide a summary high-grade complications associated with implant failure.

METHODSA comprehensive search for all relevant articles published in English from January 1995 to December 2010 was conducted. Two reviewers evaluated each study to determine whether it was eligible for inclusion and collected the data of interest. Meta-analytic pooling of results across studies was performed for the complications and failure rate.

RESULTSThirty-five primary studies with 4395 implants were identified. The three highest complications of total ankle arthroplasty were aseptic loosening (12.51%), intra-operative bone fracture (11.97%) and bony impingement (11.27%). The three high-grade complications associated with implant failure were aseptic loosening (45.00%), infection (33.00%) and malalignment (29.00%). The pooled mean failure rate was 10.98% (95%CI: 8.80% - 13.16%), and the pooled mean failure rate of STAR implant was 14.20% (95%CI: 10.64% - 17.76%).

CONCLUSIONSIt is found that aseptic loosening, infection and malalignment are high-grade complications associated with implant failure in total ankle arthroplasty. The orthopaedic surgeons should be more careful in the operation, and the patients should coordinate with the post-operative rehabilitation plan.