TOTAL ANKLE REPLACEMENT: AN ALTERNATIVE TO ANKLE ARTHRODESIS.

Ankle arthritis is a disease as debilitating as end-stage hip arthritis with equally severe mental and physical disability scores. Traditionally, ankle arthrodesis (AA) was considered the gold standard for ankle arthritis. More recently, total ankle replacement (TAR) has gained significant grounds as a valuable alternative. In Ireland, the STAR (Scandinavian Total Ankle Replacement) and Hintegra ankle prosthesis have been implanted for over 15 years.

Following ankle arthrodesis, osteoarthritis ensues at the subtalar joint in 50% of cases at 8 years and in 100% at 22 years. On the other hand, TAR preserves motion at the ankle, thereby protecting adjacent hindfoot joints from future arthritis. To avoid gross gait disturbance, TAR is preferable in patients with contralateral ankle arthrodesis. The aim is to provide a stable, balanced, mobile and painless ankle. Absolute contraindications include infection, peripheral vascular disease, neuropathy and significant avascular necrosis. Improved implant design and acceleration of surgeons’ learning curve have reduced surgical complications and increased implant survivorship to 75-90% at 10 years. Surgeons performing 21 TARs or more a year have fewer complications.

Both TAR and AA are effective treatments for ankle arthritis. Careful patient selection is essential for optimal results.