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Ankle Arthritis: Total Ankle Arthroplasty

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Orthopaedics and Trauma

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Abstract

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.

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References

  1. Doets HC, Brand R, Nelissen RG. Total ankle arthroplasty in inflammatory joint disease with use of two mobile-bearing designs. J Bone Joint Surg Am. 2006;88(6):1272–84.

    Article  PubMed  Google Scholar 

  2. Fukuda T, Haddad SL, Ren Y, Zhang LQ. Impact of talar component rotation on contact pressure after total ankle arthroplasty: a cadaveric study. Foot Ankle Int. 2010;31(5):404–11.

    Article  PubMed  Google Scholar 

  3. Haskell A, Mann RA. Ankle arthroplasty with preoperative coronal plane deformity: short-term results. Clin Orthop Relat Res. 2004;424:98–103.

    Article  Google Scholar 

  4. Wood PL, Deakin S. Total ankle replacement. The results in 200 ankles. J Bone Joint Surg Br. 2003;85(3):334–41.

    Article  CAS  PubMed  Google Scholar 

  5. Hintermann B, Valderrabano V, Dereymaeker G, Dick W. The HINTEGRA ankle: rationale and short-term results of 122 consecutive ankles. Clin Orthop Relat Res. 2004;424:57–68.

    Article  Google Scholar 

  6. Kakkar R, Siddique MS. Stresses in the ankle joint and total ankle replacement design. Foot Ankle Surg. 2011;17(2):58–63.

    Article  PubMed  Google Scholar 

  7. Vickerstaff JA, Miles AW, Cunningham JL. A brief history of total ankle replacement and a review of the current status. Med Eng Phys. 2007;29(10):1056–64.

    Article  PubMed  Google Scholar 

  8. Gougoulias N, Maffulli N. History of total ankle replacement. Clin Podiatr Med Surg. 2013;30(1):1–20.

    Article  PubMed  Google Scholar 

  9. Bedard N, Saltzman CL, Den Hartog T, Carlson S, Callaghan J, Alvine G, et al. The agility total ankle arthroplasty: a concise follow-up at a minimum of 20 years. Foot Ankle Int. 2021;42(10):1241–4.

    Article  PubMed  Google Scholar 

  10. Saltzman CL, Mann RA, Ahrens JE, Amendola A, Anderson RB, Berlet GC, et al. Prospective controlled trial of STAR total ankle replacement versus ankle fusion: initial results. Foot Ankle Int. 2009;30(7):579–96.

    Article  PubMed  Google Scholar 

  11. Singh JA, Ramachandran R. Time trends in total ankle arthroplasty in the USA: a study of the National Inpatient Sample. Clin Rheumatol. 2016;35(1):239–45.

    Article  PubMed  Google Scholar 

  12. Hobson SA, Karantana A, Dhar S. Total ankle replacement in patients with significant pre-operative deformity of the hindfoot. J Bone Joint Surg Br. 2009;91(4):481–6.

    Article  CAS  PubMed  Google Scholar 

  13. Joo SD, Lee KB. Comparison of the outcome of total ankle arthroplasty for osteoarthritis with moderate and severe varus malalignment and that with neutral alignment. Bone Joint J. 2017;99-B(10):1335-42

    Google Scholar 

  14. de Keijzer DR, Joling BSH, Sierevelt IN, Hoornenborg D, Kerkhoffs G, Haverkamp D. Influence of preoperative tibiotalar alignment in the coronal plane on the survival of total ankle replacement: a systematic review. Foot Ankle Int. 2020;41(2):160–9.

    Article  PubMed  Google Scholar 

  15. Lee GW, Wang SH, Lee KB. Comparison of intermediate to long-term outcomes of total ankle arthroplasty in ankles with preoperative varus, valgus, and neutral alignment. J Bone Joint Surg Am. 2018;100(10):835–42.

    Article  PubMed  Google Scholar 

  16. Queen RM, Adams SB Jr, Viens NA, Friend JK, Easley ME, Deorio JK, et al. Differences in outcomes following total ankle replacement in patients with neutral alignment compared with tibiotalar joint malalignment. J Bone Joint Surg Am. 2013;95(21):1927–34.

    Article  PubMed  Google Scholar 

  17. Trincat S, Kouyoumdjian P, Asencio G. Total ankle arthroplasty and coronal plane deformities. Orthop Traumatol Surg Res. 2012;98(1):75–84.

    Article  CAS  PubMed  Google Scholar 

  18. Delco ML, Kennedy JG, Bonassar LJ, Fortier LA. Post-traumatic osteoarthritis of the ankle: a distinct clinical entity requiring new research approaches. J Orthop Res. 2017;35(3):440–53.

    Article  PubMed  Google Scholar 

  19. Punzi L, Galozzi P, Luisetto R, Favero M, Ramonda R, Oliviero F, et al. Post-traumatic arthritis: overview on pathogenic mechanisms and role of inflammation. RMD Open. 2016;2(2):e000279.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Jaakkola JI, Mann RA. A review of rheumatoid arthritis affecting the foot and ankle. Foot Ankle Int. 2004;25(12):866–74.

    Article  PubMed  Google Scholar 

  21. Cho BK, An MY, Ahn BH. Comparison of clinical outcomes after total ankle arthroplasty between end-stage osteoarthritis and rheumatoid arthritis. Foot Ankle Int. 2021;42(5):589–97.

    Article  PubMed  Google Scholar 

  22. Brockett CL, Chapman GJ. Biomechanics of the ankle. Orthop Trauma. 2016;30(3):232–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ledoux WR, Sangeorzan BJ. Clinical biomechanics of the peritalar joint. Foot Ankle Clin. 2004;9(4):663–83. v

    Article  PubMed  Google Scholar 

  24. Niu W, Tang T, Zhang M, Jiang C, Fan Y. An in vitro and finite element study of load redistribution in the midfoot. Sci China Life Sci. 2014;57(12):1191–6.

    Article  PubMed  Google Scholar 

  25. Müller AM, Toepfer A, Harrasser N, Haller B, Walther M, von Eisenhart-Rothe R, Gemperlein K, Bergmann K, Bradaric C, Laugwitz KL, Ibrahim T, Dirschinger RJ. Significant prevalence of peripheral artery disease in patients with disturbed wound healing following elective foot and ankle surgery: Results from the ABI-PRIORY (ABI as a PRedictor of Impaired wound healing after ORthopedic surgerY) trial. Vasc Med. 2020;25(2):118–23. https://doi.org/10.1177/1358863X19883945. Epub 2019 Nov 15. PMID: 32366205

  26. Saltzman CL, El-Khoury GY. The hindfoot alignment view. Foot Ankle Int. 1995;16(9):572–6.

    Article  CAS  PubMed  Google Scholar 

  27. Richter M, de Cesar NC, Lintz F, Barg A, Burssens A, Ellis S. The assessment of ankle osteoarthritis with weight-bearing computed tomography. Foot Ankle Clin. 2022;27(1):13–36.

    Article  PubMed  Google Scholar 

  28. Wang Q, Zhang N, Guo W, Wang W, Zhang Q. Patient-specific instrumentation (PSI) in total ankle arthroplasty: a systematic review. Int Orthop. 2021;45(9):2445–52.

    Article  PubMed  Google Scholar 

  29. Shih CL, Chen SJ, Huang PJ. Clinical outcomes of total ankle arthroplasty versus ankle arthrodesis for the treatment of end-stage ankle arthritis in the last decade: a systematic review and meta-analysis. J Foot Ankle Surg. 2020;59(5):1032–9.

    Article  PubMed  Google Scholar 

  30. Reddy SC, Mann JA, Mann RA, Mangold DR. Correction of moderate to severe coronal plane deformity with the STAR™ ankle prosthesis. Foot Ankle Int. 2011;32(7):659–64.

    Article  PubMed  Google Scholar 

  31. Daniels TR. Surgical technique for total ankle arthroplasty in ankles with preoperative coronal plane varus deformity of 10° or greater. JBJS Essent Surg Tech. 2013;3(4).

    Google Scholar 

  32. Sung KS, Ahn J, Lee KH, Chun TH. Short-term results of total ankle arthroplasty for end-stage ankle arthritis with severe varus deformity. Foot Ankle Int. 2014;35(3):225–31.

    Article  PubMed  Google Scholar 

  33. Lee GW, Lee KB. Outcomes of total ankle arthroplasty in ankles with >20° of coronal plane deformity. J Bone Joint Surg Am. 2019;101(24):2203–11.

    Article  PubMed  Google Scholar 

  34. Hintermann B, Barg A, Knupp M, Valderrabano V. Conversion of painful ankle arthrodesis to total ankle arthroplasty. J Bone Joint Surg Am. 2009;91(4):850–8.

    Article  PubMed  Google Scholar 

  35. Pellegrini MJ, Schiff AP, Adams SB Jr, Queen RM, DeOrio JK, Nunley JA 2nd, et al. Conversion of tibiotalar arthrodesis to total ankle arthroplasty. J Bone Joint Surg Am. 2015;97(24):2004–13.

    Article  PubMed  Google Scholar 

  36. Tan EW, Maccario C, Talusan PG, Schon LC. Early complications and secondary procedures in transfibular total ankle replacement. Foot Ankle Int. 2016;37(8):835–41.

    Article  PubMed  Google Scholar 

  37. Amin A, Mahoney J, Daniels TR. Anteromedial approach for ankle arthoplasty and arthrodesis: technique tip. Foot Ankle Int. 2012;33(11):1011–4.

    Article  PubMed  Google Scholar 

  38. Cracchiolo A 3rd, Deorio JK. Design features of current total ankle replacements: implants and instrumentation. J Am Acad Orthop Surg. 2008;16(9):530–40.

    Article  PubMed  Google Scholar 

  39. Nunley JA, Caputo AM, Easley ME, Cook C. Intermediate to long-term outcomes of the STAR Total Ankle Replacement: the patient perspective. J Bone Joint Surg Am. 2012;94(1):43–8.

    Article  PubMed  Google Scholar 

  40. Mann JA, Mann RA, Horton E. STAR™ ankle: long-term results. Foot Ankle Int. 2011;32(5):S473–84.

    Article  PubMed  Google Scholar 

  41. Brunner S, Barg A, Knupp M, Zwicky L, Kapron AL, Valderrabano V, et al. The Scandinavian total ankle replacement: long-term, eleven to fifteen-year, survivorship analysis of the prosthesis in seventy-two consecutive patients. J Bone Joint Surg Am. 2013;95(8):711–8.

    Article  PubMed  Google Scholar 

  42. Yoon HS, Lee J, Choi WJ, Lee JW. Periprosthetic osteolysis after total ankle arthroplasty. Foot Ankle Int. 2014;35(1):14–21.

    Article  PubMed  Google Scholar 

  43. Hintermann B, Susdorf R, Krähenbühl N, Ruiz R. Axial rotational alignment in mobile-bearing total ankle arthroplasty. Foot Ankle Int. 2020;41(5):521–8.

    Article  PubMed  Google Scholar 

  44. Hofmann KJ, Shabin ZM, Ferkel E, Jockel J, Slovenkai MP. Salto talaris total ankle arthroplasty: clinical results at a mean of 5.2 years in 78 patients treated by a single surgeon. J Bone Joint Surg Am. 2016;98(24):2036–46.

    Article  PubMed  Google Scholar 

  45. Stewart MG, Green CL, Adams SB Jr, DeOrio JK, Easley ME, Nunley JA 2nd. Midterm results of the salto talaris total ankle arthroplasty. Foot Ankle Int. 2017;38(11):1215–21.

    Article  PubMed  Google Scholar 

  46. Schipper ON, Haddad SL, Fullam S, Pourzal R, Wimmer MA. Wear characteristics of conventional ultrahigh-molecular-weight polyethylene versus highly cross-linked polyethylene in total ankle arthroplasty. Foot Ankle Int. 2018;39(11):1335–44.

    Article  PubMed  Google Scholar 

  47. Tennant JN, Rungprai C, Pizzimenti MA, Goetz J, Phisitkul P, Femino J, et al. Risks to the blood supply of the talus with four methods of total ankle arthroplasty: a cadaveric injection study. J Bone Joint Surg Am. 2014;96(5):395–402.

    Article  PubMed  Google Scholar 

  48. Gagne OJ, Day J, Kim J, Caolo K, O’Malley MJ, Deland JT, et al. Midterm survivorship of the INBONE II total ankle arthroplasty. Foot Ankle Int. 2022;43(5):628–36.

    Article  PubMed  Google Scholar 

  49. Hsu AR, Davis WH, Cohen BE, Jones CP, Ellington JK, Anderson RB. Radiographic outcomes of preoperative CT scan-derived patient-specific total ankle arthroplasty. Foot Ankle Int. 2015;36(10):1163–9.

    Article  PubMed  Google Scholar 

  50. Hamid KS, Matson AP, Nwachukwu BU, Scott DJ, Mather RC 3rd, DeOrio JK. Determining the cost-savings threshold and alignment accuracy of patient-specific instrumentation in total ankle replacements. Foot Ankle Int. 2017;38(1):49–57.

    Article  PubMed  Google Scholar 

  51. Rushing CJ, Kibbler K, Hyer CF, Berlet GC. The INFINITY total ankle prosthesis: outcomes at short-term follow-up. Foot Ankle Spec. 2022;15(2):119–26.

    Article  PubMed  Google Scholar 

  52. Doets HC, van der Plaat LW, Klein JP. Medial malleolar osteotomy for the correction of varus deformity during total ankle arthroplasty: results in 15 ankles. Foot Ankle Int. 2008;29(2):171–7.

    Article  PubMed  Google Scholar 

  53. Demetracopoulos CA, Cody EA, Adams SB, DeOrio JK, Nunley JA, Easley ME. Outcomes of total ankle arthroplasty in moderate and severe valgus deformity. Foot Ankle Spec. 2018;12(3):238–45.

    Article  PubMed  Google Scholar 

  54. Haddad SL, Dedhia S, Ren Y, Rotstein J, Zhang LQ. Deltoid ligament reconstruction: a novel technique with biomechanical analysis. Foot Ankle Int. 2010;31(7):639–51.

    Article  PubMed  Google Scholar 

  55. Criswell B, Hunt K, Kim T, Chou L, Haskell A. Association of short-term complications with procedures through separate incisions during total ankle replacement. Foot Ankle Int. 2016;37(10):1060–4.

    Article  PubMed  Google Scholar 

  56. Schimmel JJ, Walschot LH, Louwerens JW. Comparison of the short-term results of the first and last 50 Scandinavian total ankle replacements: assessment of the learning curve in a consecutive series. Foot Ankle Int. 2014;35(4):326–33.

    Article  PubMed  Google Scholar 

  57. Gross CE, Huh J, Green C, Shah S, DeOrio JK, Easley M, et al. Outcomes of bone grafting of bone cysts after total ankle arthroplasty. Foot Ankle Int. 2016;37(2):157–64.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA

    Albert T. Anastasio, Ben Umbel, Brandon Haghverdian & Mark E. Easley

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  1. Albert T. Anastasio
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  2. Ben Umbel
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  3. Brandon Haghverdian
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  4. Mark E. Easley
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Correspondence to Mark E. Easley .

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Editors and Affiliations

  1. Division of Orthopaedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Pablo Slullitel

  2. Division of Orthopaedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Luciano Rossi

  3. Division of Orthopaedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Gastón Camino-Willhuber

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Anastasio, A.T., Umbel, B., Haghverdian, B., Easley, M.E. (2024). Ankle Arthritis: Total Ankle Arthroplasty. In: Slullitel, P., Rossi, L., Camino-Willhuber, G. (eds) Orthopaedics and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-031-30518-4_147

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  • DOI: https://doi.org/10.1007/978-3-031-30518-4_147

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