title: Total ankle replacement.
abstract: BACKGROUND
  About 1% of adults suffer from painful osteoarthritis of the ankle. The current literature contains no information on the percentage of such patients who derive long-term relief of symptoms from conservative treatment. Advanced ankle osteoarthritis can be treated with non-joint-preserving measures, such as total ankle replacement and ankle fusion.
  
  
  METHODS
  This review is based on selected relevant publications, guidelines from Germany and abroad, and the authors' personal experience.
  
  
  RESULTS
  Before surgery is considered, conservative measures such as physiotherapy and orthopedic aids should be used to the fullest possible extent. No randomized trials have yet been published comparing total ankle replacement with ankle fusion. Total ankle replacement with newer types of prosthesis yields good to very good intermediate-term and long-term results, with mean success rates of up to 90% at 10 years (range, 68-100%). Independent risk factors for the failure of ankle replacement are age over 70 years (odds ratio [OR] 3.84), primary osteoarthritis (OR 7.19), post-traumatic osteoarthritis (OR 6.2), and type of prosthesis (e.g., single hydroxyapatite coating: OR 15.04). The average range of motion of the replaced ankle joint is 25° to 30°, with values as high as 60°.
  
  
  CONCLUSIONS
  Total ankle replacement is a good treatment option for complete, end-stage ankle arthritis. It can restore joint function and make the patient mobile with little or no pain. There are, however, many contraindications to be taken into account. There is a need for further studies of the biomechanics of arthritic and replaced ankle joints and for long-term follow-up studies of total ankle replacement.
authors.affiliation: Shared authorship: Barg and Wimmer have equally contributed to the article, Department of Orthopaedics, University of Utah, USA, Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Osteoarthritis Research Center Basel, University Hospital Basel, Switzerland, Department of Orthopedics and Traumatology, Schmerzklinik Basel, Switzerland.
authors.forename: Alexej
authors.initials: A
authors.lastname: Barg
authors.forename: Matthias D
authors.initials: MD
authors.lastname: Wimmer
authors.forename: Martin
authors.initials: M
authors.lastname: Wiewiorski
authors.forename: Dieter C
authors.initials: DC
authors.lastname: Wirtz
authors.forename: Geert I
authors.initials: GI
authors.lastname: Pagenstert
authors.forename: Victor
authors.initials: V
authors.lastname: Valderrabano
mesh_terms: D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D058737:Arthroplasty, Replacement, Ankle / Q000295:instrumentation* / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D010003:Osteoarthritis / Q000175:diagnosis* / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D017755:Prosthesis Fitting / Q000379:methods; D011859:Radiography; D016896:Treatment Outcome
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