Published online Mar 18, 2026. doi: 10.5312/wjo.v17.i3.115288
Revised: November 9, 2025
Accepted: January 6, 2026
Published online: March 18, 2026
Processing time: 153 Days and 15.5 Hours
Obesity is increasingly common among patients undergoing total ankle arthroplasty (TAA), yet its influence on perioperative outcomes, implant survivorship, and patient-reported outcomes remains unclear.
To understand this relationship, which is essential for patient counseling, perioperative planning, and policy.
This systematic review, registered with the Open Science Framework and conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searched PubMed, the Cochrane Library, and CINAHL through August 2025 using: (arthroplasty OR replacement) AND ankle AND (outcome OR complication) AND obesity. Eligible studies compared obese and non-obese TAA patients. Extracted data included perioperative complications, implant revision, survivorship, and patient-reported outcome measures. Risk of bias was assessed with the Newcastle-Ottawa Scale, and due to heterogeneity, results were narratively synthesized.
Fourteen studies encompassing over 20000 patients were included. Institutional series generally found no significant association between obesity and perioperative complications, while larger databases reported increased infection, thromboembolism, and systemic risks. Implant survival findings were mixed: Institutional cohorts showed no difference, whereas registry data indicated higher revision risk. Obese patients had lower baseline function but achieved comparable, meaningful improvements. Morbidly obese patients also improved without higher short-term complication rates.
Thus, obesity should not be a contraindication for TAA, though individualized counseling on risks and benefits is recommended.
Core Tip: Obesity should not preclude total ankle arthroplasty. Although large datasets show higher complication risks, obese and morbidly obese patients experience functional improvements comparable to non-obese individuals. Pain relief, mobility, and patient-reported outcomes improve meaningfully. With appropriate patient selection, counseling, and perioperative risk management, surgeons can make careful, inclusive decisions rather than excluding patients based solely on body mass, and individualized expectations across diverse clinical settings.