Total ankle replacement: an overview of the literature

Patients with end-stage ankle arthritis have a severe degree of disability. Tibiotalar arthrodesis has been widely used successfully to treat ankle arthritis in the past. The first total ankle arthroplasties (TAAs) were introduced in 1970. Over the last 20 years, the creation of new implants has increased the survival of TAA and the benefits for the patient. Outcomes with the latest implants are better and TAA is growing in popularity for the treatment of severe ankle arthritis. For the first implants, the ideal patient for a total ankle prosthesis had to be advanced in age with low functional demands and the absence of major foot and ankle deformities. However, the most recent literature has changed the belief on indications for TAA. Despite the evolution every patient should be treated as an individual case and patient selection remains a key to the success of arthroplasty. Total ankle implants are now predominantly divided into two main categories: fixed bearing and mobile bearing, both implants perform satisfactorily with improvement in the patient's outcome. It is not yet possible to define the gold standard for the treatment of end-stage ankle arthritis. Postoperative complication can be divided in early postoperative complication and late postoperative complication. The most common postoperative problems are wound healing problems. The most common cause for revision after TAA is aseptic loosening. Most studies on modern TAA report early to midterm outcomes. Long-term follow-up studies are needed to properly assess the survival of new implants. National prosthetic registers and collaboration between institutions that perform many TAA per year will be crucial in the future to have homogeneous long-term data