Total ankle arthroplasty. Clinical study of fifty cases.

A prosthesis for the ankle joint that I designed in 1973 was implanted in fifty patients who otherwise would have required fusion of the ankle to relieve severe pain. The design of the device allows about as much motion as in the normal ankle. During implantation of the prosthesis the dome of the talus is not resected and only one centimeter of the distal end of the tibia is removed. If the prosthetic replacement is unsuccessful, fusion of the ankle can more easily be achieved secondarily if it should become necessary. Review of the cases of these fifty patients showed that the best results were obtained in the patients with degenerative arthritis whose ankles were stable and not unduly deformed. A few patients with rheumatoid arthritis (four of ten) who were not on long-term steroid therapy also did well. Contraindications revealed by my experience include avascular necrosis of the talus, pseudarthrosis at the site of a previously attempted ankle fusion, and conditions causing talar tilt of 20 degrees or more.