title: History and evolution in total ankle arthroplasty.
abstract: BACKGROUND
  The current study provides an overview of history and evolution in total ankle arthroplasty.
  
  
  METHODS
  We conducted a comprehensive literature search without limitations to language. Information from any source, providing evidence of the use ankle of prostheses (e.g. biomechanical testing, cadaveric implantations or clinical use) was evaluated. Data regarding biomechanical concepts, design considerations, published results (patient numbers, surgical method, follow-up, complications and survival rates) were collected.
  
  
  RESULTS
  Only level IV studies were found. Mobile-bearing prostheses are mainly used in Europe, and fixed-bearing implants are mainly used in the USA. The current designs' failure rate is 10-12% at approximately 5 years. Survival rates vary among different institutions. Increased surgeons' experience is associated with better outcomes.
  
  
  CONCLUSIONS
  Biomechanical studies and review of previous implant failures has led to the development of a new generation of implants.
  
  
  CONCLUSIONS
  Results show that ankle arthroplasty is a viable alternative for the management of ankle arthritis in selected patients.
authors.affiliation: Keele University School of Medicine, Thornburrow Drive, Hartshill, Stoke on Trent, Staffordshire, UK.
authors.forename: Nikolaos E
authors.initials: NE
authors.lastname: Gougoulias
authors.forename: Anil
authors.initials: A
authors.lastname: Khanna
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
mesh_terms: D000843:Ankle Joint / Q000601:surgery*; D001168:Arthritis / Q000601:surgery; D019643:Arthroplasty, Replacement / Q000592:standards*; D001696:Biomechanical Phenomena; D006801:Humans; D007595:Joint Prosthesis / Q000592:standards*; D011474:Prosthesis Design / Q000592:standards*