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Abstract
Ankle fusions have traditionally been the treatment of choice for end-stage ankle pathology refractory to no operative treatment. Initially performed over 100 years ago, Complication rates as high as 34–60%, have been reported, although results have improved with modern AO techniques. Total ankle arthroplasty is emerging as a viable treatment for patients with symptomatic tibiotalar arthritis who have not responded to no operative treatment.
Achieving a successful arthroplasty of the ankle joint is complex.
For similar loads, the forces across the ankle are much greater than at knee or hip .The ankle is not a simple hinge joint but has a complex mechanics involving rotation and translation
Previous recommendations that TAA is contra indicted in any situation have been modified.
Indications of TAA are still being defined, particularly because the mean periods of follow – up for all current TAA prostheses are relatively short.
In an effort to relieve pain, yet retain motion in the arthritic ankle joint, prosthesis was devised and has been inserted successfully since 1973
Buchholz has been credited with performing the 1st TAA in Hamburg
First generation TAA was developed as an alternative to ankle arthrodesis. Subsequent reports of severe osteolysis, component loosening, impingement, infection, and soft tissue breakdown led to its abandonment in most centers.
The failures are believed to be a result of poor prosthetic design, inadequate fixation, poor soft-tissue management, mal-alignment, and lack of soft- tissue balancing.
TPR, MAYO, SMITH, and the Beck-steffe ankles are examples of this historical generation.
A new generation of uncemented semiconstrained ankle arthroplasties was designed and has been implanted since the 1980s.
Relied upon metallurgy improvements, more sophisticated instrumentation, and a better understanding of ankle joint biomechanics. There has also been a trend for prosthesis that use biologic fixation, which has also shown better results than cemented implants
STAR, Agility, SALTO, HENTIGRA, Buechel-Pappas, TNK, AES, ESKA, ALBATROS, ALPHANORM and RAMSIS ankles are examples of the second-generation ankles.
Earlier generations of total ankle arthroplasties were plagued with high complication rates and poor results
While second generation follow up is encouraging, although more follow up is needed and at the same time, some studies are not yet published.
Total ankle arthroplasty should be considered as line of treatment besides arthrodesis, but with a lot more advantages, like maintaining the range of motion, pain control, and preserving the neighboring joints.
In case of failed ankle replacement, salvage is possible nearly in al cases, so surgeons have nothing to loose.
Insisting on using arthrodesis only is meaningless, because that makes patients have a lot to miss.