[Osteoarthritis of the ankle: to offload, fuse or replace?]

Symptomatic ankle osteoarthritis is associated with a substantial disease burden. Although many patients benefit from nonsurgical management, surgical intervention is commonly indicated for endstage osteoarthritis. In recent years, total ankle arthroplasty (TAA) has gained popularity. Patient A: 90 y/o female, severe comorbidities, idiopathic ankle osteoarthritis, orthopedic shoe adaptation. Patient B: 58 y/o female, healthy, arthrodesis for osteoarthritis due to chronic instability, pain-free after one year, full consolidation. Patient C: 66 y/o male, healthy, TAA for posttraumatic osteoarthritis, pain-free one year after surgery with good ankle mobility. The choice of treatment is guided by patient-specific characteristics. Nonoperative management is generally preferred for individuals with mild symptoms, minimal osteoarthritic changes, or those who are non-operable. Arthrodesis is typically indicated for younger, physically active, or heavier patients, whereas total ankle arthroplasty (TAA) is more suitable for relatively older, moderately active patients with a flexible, neutrally-aligned ankle. Overall, management of ankle osteoarthritis is individualized, and TAA can be an effective option for appropriately selected patients.