Beyond Early Complications: Diabetic Neuropathy Is Associated With Progressive Failure, Reoperation, and Mortality After Ankle Arthrodesis

Background Diabetic peripheral neuropathy may affect outcomes after ankle arthrodesis, but its specific impact on infection, mechanical failure, reoperation, mortality, and healthcare utilization after ankle arthrodesis remains incompletely defined. This study compared postoperative complications, reoperations, and healthcare use after ankle arthrodesis in diabetic patients with and without neuropathy. Methods A retrospective cohort study was performed using the TriNetX Research Network, a multicenter federated electronic health record database. The analysis conducted included patients from January 2020 to January 2025. Adult diabetic patients undergoing primary ankle arthrodesis for osteoarthritis were identified and stratified by the presence or absence of preoperative diabetic peripheral neuropathy. After 1:1 propensity score matching, 731 patients were in each group. Outcomes at 1, 3, and 5 years included mechanical failure, revision arthrodesis, subsequent ankle surgery, postoperative infection, mortality, and emergency department use. Results Patients with diabetic peripheral neuropathy experienced a consistently greater postoperative complication burden following ankle arthrodesis compared with diabetic patients without neuropathy. Across short-, intermediate-, and long-term follow-up, neuropathy was associated with significantly higher rates of postoperative infection, mechanical failure, and emergency department utilization. At longer-term follow-up, patients with neuropathy also demonstrated greater rates of revision arthrodesis, subsequent ankle surgery, and mortality. Differences in venous thromboembolism and myocardial infarction were not significant between groups. Conclusions Diabetic peripheral neuropathy was associated with increased complications, reoperation, healthcare utilization, and long-term morbidity after ankle arthrodesis. It should be recognized as a key risk factor in perioperative planning, patient counseling, and postoperative surveillance.