Challenges in Total Ankle Arthroplasty

Abstract

In the past, total ankle arthroplasty was largely abandoned due to poor survivorship most often caused by loss of bone support. High complication rates were also reported. Despite this, there is renewed interest in ankle arthroplasty and encouraging results are seen in survivorship with midterm follow-up. The procedure, however, remains more challenging than total hip or total knee arthroplasty. With the limited soft tissue envelope, wound problems are not uncommon. Forces at the ankle are very large and yet the surface area for prosthetic support is small. Therefore, fixation can be more difficult. The strongest bone can be eccentric at the distal tibia. The tibial prosthesis can, therefore, tend to settle into the softer bone often laterally. Polyethylene needs to be sufficiently thick to maintain its integrity but that requires a larger bone resection, which weakens bone support. Polyethylene failure or wear leads to the majority of failures in hip and knee arthroplasty. There is a need for further basic science research in total ankle arthroplasty. The lessons learned from other arthroplasty should be considered in ankle arthroplasty design.

Computational modelling of polyethylene wear and creep in total hip joint replacements: Effect of the bearing clearance and diameter

“…[2][3][4][5] The PE total hip joints, consisting of a UHMWPE cup and a metallic/ceramic femoral head, are clinically the most widely implanted. The bearing surface wear and PE wear debris in the artificial joint have been the main causes of implant failure limiting the long-term performance of the joint replacement treatment.…”

Force-controlled dynamic wear testing of total ankle replacements

“…This is mainly attributed to the currently used TAR generation which shows improvements in surgical technique, uncemented implant fixation and minimally constrained articulation [1,2]. Clinically, results are promising [3][4][5], especially when compared to earlier attempts in TAR [6].…”

Follow-up study of ankle arthrodesis in severe hind foot deformity in patients with rheumatoid arthritis using an intramedullary nail with fins

“…Despite this, in recent years early reports of TAA have been very encouraging with good short-term results. 11,12 In RA patients having severe pain of ankle joints and restricted ADL due to multiple joint arthroplasties, it is very important that they are relieved of their ankle joint pain, which will result in the improvement of their ADL. Firm internal fixation for ankle arthrodesis has the following advantages: shortening of the period of immobilization, exact osseous fusion of the ankle joint, and earlier return to routine function.…”