Total ankle arthroplasty using biological fixation components compared to ankle arthrodesis

Area of Science:

• Orthopedic Surgery
• Biomaterials Science

Background:

• Tibiotalar arthrodesis is the standard surgical treatment for severe ankle joint disease when conservative measures fail.
• Ankle fusion often results in complications, persistent pain, and impaired function, unlike hip and knee arthroplasties.
• Current salvage procedures for painful ankle fusions are inadequate, and fusion can lead to gait handicaps, especially with bilateral involvement or adjacent joint fusion.

Purpose of the Study:

• To address the limitations of tibiotalar arthrodesis and the need for a successful long-term total ankle arthroplasty.
• To evaluate the potential of cementless fixation in total ankle arthroplasty as an alternative to traditional cemented procedures.

Main Methods:

• Review of current surgical treatments for ankle joint disease, focusing on tibiotalar arthrodesis and total ankle arthroplasty.
• Evaluation of the PCA (Proportional Counter Array) concept for biological cementless fixation.
• Analysis of the Scholz total ankle prosthetic components utilizing cementless fixation.

Main Results:

• Tibiotalar arthrodesis has a significant complication rate and does not consistently restore normal function or eliminate pain.
• Cement-fixed total ankle arthroplasty remains controversial, with polymethylmethacrylate and design modifications not providing a definitive solution.
• Initial results using the PCA concept with cementless fixation for Scholz total ankle prosthetics show promise for improved arthroplasty success.

Conclusions:

• Maintenance of tibiotalar motion is crucial for managing ankle arthritis, suggesting fusion is not universally applicable.
• A successful, long-term total ankle arthroplasty is needed to overcome the shortcomings of fusion.
• Cementless fixation, exemplified by the PCA concept with Scholz components, represents a potential advancement in total ankle arthroplasty outcomes.