End-stage ankle arthritis: magnitude of the problem and solutions

Patients with end-stage ankle arthritis have a significantly compromised health-related quality of life. Nonsurgical treatments for end-stage ankle arthritis should be considered prior to surgery. Currently, the most accepted surgical treatment is ankle arthrodesis. The shortcomings of ankle arthrodesis, such as increased rates of ipsilateral periarticular arthritis and the possible long-term need for amputation, have cast doubt on the success of this treatment for end-stage ankle arthritis. Newer second and third generation total ankle arthroplasty prostheses have shown positive short- and medium-term results. An examination of the available literature provides good evidence to support ankle arthrodesis and total ankle arthroplasty for treating patients with end-stage ankle arthritis. Other treatment options, including ankle osteotomies, ankle osteochondral allograft transplantation, and distraction arthroplasty, require further study by surgeons with advanced training in these procedures.