Complications of total ankle replacement

Total ankle arthroplasty is emerging as a viable treatment for patients wit h symptomatic tibiotalar arthritis who have not responded to nonoperative t reatment. First generation ankle replacement prostheses had significant com plications, leading many orthopaedic surgeons to abandon their use. Second generation designs have attempted to address some of these problems wit inn ovative new designs. Ankle arthritis differs from other forms of degenerati ve arthritis in that the majority is posttraumatic in origin, and occurs in a younger age group. Correction of alignment is complicated by deformity o f the foot distal to the ankle. Published results of second generation ankl e replacement systems are limited, and the understanding of them is necessa rily anecdotal. In the current study, complications of current second gener ation total ankle arthroplasty are divided into preoperative or patient sel ection problems, complications related to prosthetic design, intraoperative , and postoperative complications. Solutions, or the controversies surround ing those complications that have no obvious solution, will be discussed wh en appropriate. Total ankle arthroplasty with these second generation prost heses is gaining increasing popularity. The surgeon contemplating total ank le arthroplasty should have an understanding of anatomy and lower extremity biomechanics, and a thorough knowledge of the total ankle system he or she decided to use.