{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T19:02:13Z","timestamp":1789844533390,"version":"4.0.1"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":55,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The optimal surgical approach for total ankle arthroplasty (TAA) remains debated. The anterior and lateral transfibular approaches differ in surgical exposure and may influence complication patterns. This systematic review and meta\u2010analysis aimed to compare revision rates, overall complication rates and specific complication profiles between anterior and lateral approaches in TAA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A PRISMA\u2010compliant systematic review of PubMed, Embase and Scopus databases was performed. Studies reporting complications following primary TAA performed through either approach were included if they met predefined methodological quality criteria (QualSyst score\u2009\u2265\u200975%). Complication rates were compared using Fisher's exact test, and correlations between complication rates and patient or surgical factors were explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010one studies were included, comprising 7959 TAA procedures (7225 anterior and 734 lateral). Revision rates were higher in the anterior approach group (7.5% vs. 1.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), as were rates of malleolar fractures (1.7% vs. 0.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and aseptic loosening (2.8% vs. 0.14%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Deep infections were reported more frequently in lateral approach cohorts (3.1% vs. 0.57%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), although this finding was influenced by outlier studies. Wound complications and polyethylene\u2010related complications were comparable between approaches. No association was observed between complication rates and patient age, body mass index or surgical time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Anterior and lateral approaches in TAA appear to be associated with different complication patterns rather than clear differences in overall safety. Both approaches remain valid surgical options, but awareness of their distinct complication profiles may help guide intraoperative precautions and post\u2010operative surveillance. However, heterogeneity in implant design, follow\u2010up duration and study methodology limits definitive conclusions regarding the superiority of one approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level I, systematic review\/meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70774","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T12:57:10Z","timestamp":1779800230000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Different complication patterns between anterior and lateral approaches in total ankle arthroplasty: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"13","author":[{"given":"Giammarco","family":"Gardini","sequence":"first","affiliation":[{"name":"Istituto Ortopedico Rizzoli U.O. Ortopedia Bentivoglio Bentivoglio Bologna Italy"},{"name":"Department of Biomedical and Neuromotor Sciences DIBINEM Alma Mater Studiorum University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Mosca","sequence":"additional","affiliation":[{"name":"Istituto Ortopedico Rizzoli U.O. Ortopedia Bentivoglio Bentivoglio Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1111-5869","authenticated-orcid":false,"given":"Tosca","family":"Cerasoli","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Neuromotor Sciences DIBINEM Alma Mater Studiorum University of Bologna Bologna Italy"},{"name":"2nd Orthopaedic and Traumatologic Clinic IRCCS Rizzoli Orthopaedic Institute Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio Maria","family":"Marcheggiani Muccioli","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Neuromotor Sciences DIBINEM Alma Mater Studiorum University of Bologna Bologna Italy"},{"name":"2nd Orthopaedic and Traumatologic Clinic IRCCS Rizzoli Orthopaedic Institute Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Capodagli","sequence":"additional","affiliation":[{"name":"Istituto Ortopedico Rizzoli U.O. Ortopedia Bentivoglio Bentivoglio Bologna Italy"},{"name":"Department of Biomedical and Neuromotor Sciences DIBINEM Alma Mater Studiorum University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Viotto","sequence":"additional","affiliation":[{"name":"Istituto Ortopedico Rizzoli U.O. Ortopedia Bentivoglio Bentivoglio Bologna Italy"},{"name":"Department of Biomedical and Neuromotor Sciences DIBINEM Alma Mater Studiorum University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesar de Cesar","family":"Netto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Foot and Ankle Division Duke University School of Medicine Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvio","family":"Caravelli","sequence":"additional","affiliation":[{"name":"Istituto Ortopedico Rizzoli U.O. Ortopedia Bentivoglio Bentivoglio Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.L.00520"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2012.10.009"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1453-y"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2014.04.001"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.01580"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2014.09.012"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-017-3605-0"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2024.05.007"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-017-3583-2"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/1071100720920276"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2024.02.001"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2022.07.004"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.foot.2018.07.001"},{"key":"e_1_2_14_15_1","volume-title":"HTA initiative","author":"Kmet L","year":"2004"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/24730114241294073"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.L.00572"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2019.10.011"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13070841"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-013-1971-9"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.3390\/app13010535"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/1071100719879680"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2021.03.001"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/10711007241309901"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2025.102950"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2016.0364"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.btf.0000160715.26694.54"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/17453670710014257"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/19386400221109420"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/1071100713477610"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2017.07.643"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fcl.2023.08.003"},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.91B1.21346"},{"key":"e_1_2_14_34_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011332"}],"container-title":["Journal of Experimental Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jeo2.70774","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jeo2.70774","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jeo2.70774","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:15:02Z","timestamp":1789841702000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/jeo2.70774"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":33,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/jeo2.70774"],"URL":"https:\/\/doi.org\/10.1002\/jeo2.70774","archive":["Portico"],"relation":{},"ISSN":["2197-1153","2197-1153"],"issn-type":[{"value":"2197-1153","type":"print"},{"value":"2197-1153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-11-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70774"}}