Total ankle arthroplasty using biological fixation components compared to ankle arthrodesis

When conservative measures fail to alleviate pain and disability of ankle joint disease, tibiotalar arthrodesis is the present accepted surgical treatment. Unfortunately, ankle arthrodesis also carries a significant rate of complications and the success rate does not parallel the results of hip and knee joint arthroplasties. A large percentage of ankle arthrodeses remain painful, and function is not normal. There is no satisfactory "salvage procedure" to a painful ankle fusion. Patients with primary ankle arthritis tend to develop bilateral ankle involvement as well as involvement of the subtalar and midtarsal joints; bilateral ankle fusion results in a severe handicap to gait and function. Ankle fusion with involvement of the subtalar or midtarsal joints might well result in a painful fusion. Maintenance of tibiotalar motion appears essential in both instances. It is apparent that all ankle problems cannot be dealt with by fusion and a successful long-term ankle arthroplasty is needed. Total ankle arthroplasty using cement fixation remains controversial. Continued use of polymethylmethacrylate and additional design changes do not appear to be the answer to possible ankle joint replacement. Initial success using the PCA concept of biological cementless fixation of the Scholz total ankle prosthetic components appears to offer a new dimension in the success of total ankle arthroplasty.