Current concepts review: total ankle arthroplasty

Area of Science:

• Orthopaedics
• Biomedical Engineering

Background:

• First and second-generation total ankle arthroplasties (TAA) were associated with high complication and failure rates, leading many orthopaedic surgeons to favor arthrodesis.
• Recent advancements, including longer-term outcome studies and new FDA-approved designs, have spurred renewed interest in TAA.
• The introduction of two new FDA-approved implants in November 2006 significantly expanded surgical options for TAA.

Purpose of the Study:

• To provide orthopaedists with an overview of currently available total ankle arthroplasty implants.
• To review the existing literature on TAA outcomes and compare them to arthrodesis.
• To address the ongoing debate regarding indications, patient selection, and optimal component design for TAA.

Main Methods:

• Literature review of studies on total ankle arthroplasty outcomes.
• Analysis of FDA approvals and implant designs for TAA.
• Synthesis of current evidence regarding TAA complications, failure rates, and comparison with arthrodesis.

Main Results:

• Historically high failure rates of early TAA designs led to decreased usage.
• Recent TAA designs show improved outcomes, though long-term data is still evolving.
• Significant debate persists within the orthopaedic community regarding optimal TAA indications and patient selection.

Conclusions:

• The landscape of total ankle arthroplasty has evolved with new implant options and emerging outcome data.
• Careful patient selection and consideration of implant design are crucial for successful TAA.
• Further research and long-term studies are necessary to fully establish the role of TAA compared to arthrodesis.