Will Total Ankle Arthroplasty Become the New Standard for End-Stage Ankle Arthritis?

Autoinflammation Around AES Total Ankle Replacement Implants

“…Between 2009 and 2010, samples were collected from the synovial membrane and cyst contents from 10 patients undergoing revision for peri-implant osteolysis of AES (Transystème, Nîmes; distributed by Biomet, Valence, France) TAR implant, as described in our previous study. 10 In preoperative CT scans, all patients had discrete, wellcircumscribed areas of granulomatous lucencies ≥10 mm in the peri-implant bone. In spite of marked osteolysis around the TAR implants also seen in revision, all except 1 implant were intraoperatively found to be fixed to the bone.…”

“…Total ankle replacement (TAR) is today one of the options for the operative treatment of end-stage ankle arthritis that provides satisfactory results in both the intermediate and long term. 1,4,[9][10][11]26 Nevertheless, concerns remain, and the complication rate is still higher compared to knee and hip replacements. 6,8,17 The most common reason for implant failure is aseptic loosening, in many cases associated with particles and foreign body response against them.…”

Patient selection for total ankle arthroplasty

“…The number of total ankle replacements (TARs) performed is ever increasing,1–8 and indications are expanding2 due to improvements in design and outcome. Historically, osteonecrosis/loss of bone stock,9–14 neuroarthropathy,9–11,13,14 (diabetic) neuropathy,12 diabetes,15 peripheral vascular disease,9–13 smoking,15 poor skin integrity/envelope,9,11 osteoporosis,9,11,13 (gross) deformity,9,10,12,13,16 noncompliancy,12 high physical demand/body mass index (BMI),9,12,13,15,16 marked ankle instability9,10,16 and (a history of) joint infection9–14 are considered (relative) contraindications to modern total ankle arthroplasty, but the scientific basis for these recommendations is scarce.…”

Reduction in Wound Complications After Total Ankle Arthroplasty Using a Compression Wrap Protocol

“…The use of total ankle arthroplasty (TAA) has risen significantly over the past 2 decades, and wound care and early mobilization have become key tenets of postoperative management. [7][8][9][10][11]13,19 Meticulous dissection and handling of the soft tissue envelope, close incision monitoring, and progressive mobilization with physical therapy (after early wound healing) are all paramount to minimizing woundrelated problems after surgery. Significant postoperative ankle and hindfoot edema can increase the risk of wound complications as well as infection.…”