{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:23:10Z","timestamp":1791919390237,"version":"4.3.4"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>End-stage ankle osteoarthritis (OA) is primarily post-traumatic, following injuries such as fractures, dislocations, and sprains. However, the timeline between initial injury and end-stage OA requiring surgical intervention remains poorly understood. This retrospective study aimed to identify injury patterns leading to post-traumatic osteoarthritis (PTOA) and determine the time from injury to definitive surgical treatment with ankle fusion (AF) or total ankle replacement (TAR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted using medical records of patients who underwent AF or TAR for end-stage OA at a tertiary institution over a 20-year period (2000-2020). Patients were classified into post-traumatic, primary, or secondary OA categories. In PTOA cases, initial injury radiographs were reviewed and classified. The time from injury to surgical intervention was analyzed, and a multivariate regression analysis assessed factors influencing the progression to end-stage OA<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 491 ankles from 479 patients were included, with 81.3% categorized as PTOA. The most common injury was rotational ankle fractures (47.1%), followed by ankle sprains (27.6%) and pilon fractures (15.3%). The average time from injury to AF\/TAR was 16.9 years, with pilon fractures progressing the fastest (8.1 years) and tibial shaft fractures the slowest (32.7 years). Factors significantly influencing time to surgery included injury type (p &lt; 0.00001), age (p &lt; 0.00001), smoking status (p = 0.016), and peripheral neuropathy (p = 0.04).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>PTOA is the leading cause of end-stage ankle OA, with rotational ankle fractures and ankle sprains being the most common etiologies. High-energy injuries progress more rapidly, while lower-energy injuries contribute significantly due to their high prevalence. These findings may contribute to a better understanding of the epidemiology and risk factors of end-stage ankle OA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Observational comparative study;\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.25.00277","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T18:00:23Z","timestamp":1776189623000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["End-Stage Ankle Osteoarthritis"],"prefix":"10.2106","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6037-0685","authenticated-orcid":false,"given":"Cesar","family":"de Cesar Netto","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristopher","family":"Cychozs","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Iowa (UIOWA), Iowa City, Iowa"},{"name":"Department of Orthopaedics, Slocum Center for Orthopaedics and Sports Medicine, Eugene, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nacime Salom\u00e3o","family":"Barbachan Mansur","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7885-7122","authenticated-orcid":false,"given":"Elijah","family":"Auch","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Iowa (UIOWA), Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8135-5169","authenticated-orcid":false,"given":"William","family":"Lorentzen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Iowa (UIOWA), Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4328-9855","authenticated-orcid":false,"given":"Bopha","family":"Chrea","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Iowa (UIOWA), Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0163-6516","authenticated-orcid":false,"given":"Francois","family":"Lintz","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1640-6107","authenticated-orcid":false,"given":"Donald","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Iowa (UIOWA), Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4]]},"reference":[{"key":"R1-20260414","first-page":"44","article-title":"Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center","volume":"25","author":"Saltzman","year":"2005","journal-title":"Iowa Orthop J."},{"issue":"5","key":"R2-20260414","doi-asserted-by":"crossref","first-page":"320","DOI":"10.5435\/00124635-200109000-00005","article-title":"Primary osteoarthritis of the hip: etiology and epidemiology","volume":"9","author":"Hoaglund","year":"2001","journal-title":"J Am Acad Orthop Surg"},{"issue":"3","key":"R3-20260414","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.cger.2010.03.001","article-title":"Epidemiology of osteoarthritis","volume":"26","author":"Zhang","year":"2010","journal-title":"Clin Geriatr Med."},{"issue":"2","key":"R4-20260414","doi-asserted-by":"crossref","first-page":"e29","DOI":"10.5435\/JAAOS-D-15-00354","article-title":"Ankle arthritis: you can't always replace it","volume":"24","author":"Hayes","year":"2016","journal-title":"J Am Acad Orthop Surg"},{"issue":"7","key":"R5-20260414","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1007\/s11999-008-0543-6","article-title":"Etiology of ankle osteoarthritis","volume":"467","author":"Valderrabano","year":"2009","journal-title":"Clin Orthop Relat Res."},{"key":"R7-20260414","first-page":"105","article-title":"The operative treatment of intra-articular fractures of the lower end of the tibia","volume":"138","author":"Ruedi","year":"1979","journal-title":"Clin Orthop Relat Res."},{"issue":"5","key":"R8-20260414","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1001\/archsurg.1950.01250010980011","article-title":"Fractures of the ankle. 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