Total ankle replacement: why, when and how?
Total ankle replacement (TAR) was first attempted in the 1970s, but poor results led to its being considered inferior to ankle fusion until the late 1980s and early 1990s. By that time, newer designs which more closely replicated the natural anatomy of the ankle, showed improved clinical outcomes. Currently, even though controversy still exists about the effectiveness of TAR compared to ankle fusion, TAR has shown promising mid-term results and should no longer be considered an experimental procedure. Factors related to improved TAR outcomes include: 1) better patient selection, 2) more precise knowledge and replication of ankle biomechanics, 3) the introduction of less-constrained designs with reduced bone resection and no need for cementation, and 4) greater awareness of soft-tissue balance and component alignment. When TAR is performed, a thorough knowledge of ankle anatomy, pathologic anatomy and biomechanics is needed along with a careful pre-operative plan. These are fundamental in obtaining durable and predictable outcomes. The aim of this paper is to outline these aspects through a literature review.
Mauriziano Umberto I Hospital, Department of Orthopaedics and Traumatology, University of Torino Medical School, Largo Turati 62, 10128, Torino, Italy.
Davide Edoardo
DE
Bonasia
Federico
F
Dettoni
John E
JE
Femino
Phinit
P
Phisitkul
Margherita
M
Germano
Annunziato
A
Amendola
D016512:Ankle Injuries / Q000473:pathology / Q000601:surgery*; D000843:Ankle Joint / Q000473:pathology / Q000601:surgery*; D058737:Arthroplasty, Replacement, Ankle / Q000295:instrumentation / Q000379:methods*; D001696:Biomechanical Phenomena; D006801:Humans; D018579:Patient Selection; D019736:Prostheses and Implants; D016896:Treatment Outcome