Complications of total ankle replacement.

Total ankle arthroplasty is emerging as a viable treatment for patients with symptomatic tibiotalar arthritis who have not responded to nonoperative treatment. First generation ankle replacement prostheses had significant complications, leading many orthopaedic surgeons to abandon their use. Second generation designs have attempted to address some of these problems with innovative new designs. Ankle arthritis differs from other forms of degenerative arthritis in that the majority is posttraumatic in origin, and occurs in a younger age group. Correction of alignment is complicated by deformity of the foot distal to the ankle. Published results of second generation ankle replacement systems are limited, and the understanding of them is necessarily anecdotal. In the current study, complications of current second generation total ankle arthroplasty are divided into preoperative or patient selection problems, complications related to prosthetic design, intraoperative, and postoperative complications. Solutions, or the controversies surrounding those complications that have no obvious solution, will be discussed when appropriate. Total ankle arthroplasty with these second generation prostheses is gaining increasing popularity. The surgeon contemplating total ankle arthroplasty should have an understanding of anatomy and lower extremity biomechanics, and a thorough knowledge of the total ankle system he or she decided to use.