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Primary and revision total ankle replacement using custom-designed prostheses.

Mark S Myerson¹, Hugh Y Won

¹Institute for Foot and Ankle Reconstruction, Mercy Medical Center, 301 St. Paul Place, Baltimore, MD 21202, USA. mark4feet@aol.com

Foot and Ankle Clinics

|August 12, 2008

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Custom prostheses enhance mechanical stability for failed ankle replacements and can help more patients, even with poor bone support. Preoperative imaging and intraoperative techniques ensure successful outcomes for complex cases.

Area of Science:

Orthopedic Surgery
Biomedical Engineering
Reconstructive Surgery

Background:

Total ankle replacement (TAR) failures present significant challenges in salvage procedures.
Suboptimal bony support has historically limited TAR candidacy.
Custom prostheses offer potential solutions for complex ankle reconstruction.

Purpose of the Study:

To review the history and challenges associated with total ankle replacement failures.
To describe the surgical techniques and applications of custom ankle prostheses.
To highlight tips and potential pitfalls in utilizing custom prostheses for ankle salvage and primary arthroplasty.

Main Methods:

Discussion of historical data on total ankle replacement outcomes.
Detailed explanation of custom prosthesis design and preoperative planning using imaging and templating.

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Description of intraoperative techniques, including the use of adjuncts like screws, plates, and bone grafts.

Main Results:

Custom prostheses provide improved mechanical stability and fixation, aiding in the salvage of failed TARs.
Custom implants can overcome previous contraindications related to poor bone stock, expanding patient eligibility.
Adjuncts effectively manage intraoperative challenges such as bone defects and deformities.

Conclusions:

Custom prostheses represent a valuable advancement in managing failed total ankle replacements.
Accurate preoperative planning and intraoperative flexibility are crucial for successful custom prosthesis implantation.
Custom implants broaden the scope of patients who can benefit from ankle arthroplasty, including those with complex deformities.