[Prosthetic replacement of the upper ankle joint].
Results after total ankle arthroplasty in the 1970s and 1980s were poor. The outcomes of these surgeries deteriorated rather dramatically with time. Causes of failure were multifactorial, but the two main reasons for failure were constrained designs and cement fixation. Today, the design of total ankle arthroplasty is unconstrained and the fixation is uncemented. Total ankle arthroplasties are considered technically demanding procedures, with relatively high early postoperative complication rates. As yet, the ideal total ankle patient remains to be defined. Good alignment and ligamentous stability are essential. Osteonecrosis and profound osteoporosis are associated with poor results due to problems with bony fixation. Patients should be advised that the implant may fail and that this may require further surgery, including the potential need for an ankle fusion. The results of ankle fusions, although usually initially good, seem to deteriorate with time. Not uncommonly, patients frequently develop peritarsal degenerative joint disease several years after an ankle arthrodesis. Because of the associated pain and functional limitations that can follow ankle fusion, efforts to develop a workable total ankle replacement continue. At present, the long-term results of new designs are unknown. Today, total ankle arthroplasty should be limited to centers where patient volume and infrastructure allows critical review and prospective clinical trials to determine the factors leading to successful and unsuccessful outcomes.
Thermann
H
H
Zentrum für Knie- und Fusschirurgie, ATOS-Klinik, Bismarckstrasse 9-15, 69115 Heidelberg. thermann@atos.de
Saltzman
C L
CL
D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000639:trends; D005544:Forecasting; D006801:Humans; D007595:Joint Prosthesis / Q000639:trends*; D010003:Osteoarthritis / Q000601:surgery; D010020:Osteonecrosis / Q000601:surgery; D011474:Prosthesis Design / Q000639:trends; D011475:Prosthesis Failure; D012086:Reoperation / Q000639:trends