Total ankle replacement revisited

The surgical treatment of painful, end-stage ankle arthritis includes ankle arthrodesis and total ankle replacement. In the past decade, total ankle r eplacement has become a viable alternative to ankle arthrodesis. Modern imp lant designs either involve a syndesmosis fusion and resurfacing of the med ial and lateral recesses of the ankle joint or the use of a 3-component, mo bile bearing implant. In limited clinical series, the early results of both these prosthetic design approaches are encouraging. In selected patients, ankle arthroplasty is an effective approach to relieving pain and improving function. The purposes of this paper are to review the clinical results fr om total ankle replacement and ankle arthrodesis; discuss indications, cont raindications, design features, postoperative rehabilitation, and initial r esults for the major current total ankle designs; and present concepts for future total ankle development. In particular, this article explores the ad vantages and concerns with 2 prevalent but different design approaches. It also discusses future directions for total ankle replacement.