Ankle arthritis: Total ankle arthroplasty
The ankle joint is a complex structure, comprised of articulations between the distal tibia, the fibula, and the talus and constrained by multiple surrounding ligaments. Despite the high proteoglycan synthesis rate of ankle joint chondrocytes, posttraumatic arthritis is the most common etiology for end-stage arthritis of the ankle. In select patients, especially patients who are too young for total ankle arthroplasty (TAA), some surgeons recommend ankle distraction arthroplasty; however, the majority of end-stage ankle arthritis is managed with either ankle arthrodesis (fusion) or TAA. As techniques and outcomes improve, the indications for TAA are expanding, with many more surgeons favoring arthroplasty over arthrodesis. Several design factors such as mobile-bearing versus fixed-bearing prostheses, resurfacing versus flat cut talar components, intramedullary versus extramedullary referencing for component alignment, and, more recently, three-dimensional (3D) printing of patient-specific instrumentation (PSI). Outcomes of TAA are generally favorable, but surgeons performing TAA must be prepared to manage potential complications such as wound breakdown, implant loosening, and infection.
