AANA Lab Course 908-Foot and Ankle Arthroscopy (APEx)-Total Ankle Replacement_ Improvements Make It Appropriate Even in Young and Active-Eric Giza, M.D.

Total Ankle Replacement_ Improvements Make It Appropriate Even in Young and Active-Eric Giza, M.D.

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This comprehensive presentation by Dr. Eric Giza discusses the management of ankle osteoarthritis (OA), focusing on total ankle replacement (TAR) versus ankle arthrodesis (AA).<br /><br />Ankle OA, though less common than hip or knee OA, significantly impairs quality of life, with pain and disability comparable to hip OA. Most ankle OA is post-traumatic and affects a relatively young population.<br /><br />AA advantages include a stable, pain-free foot with expected normal gait on flat surfaces, correction of deformities, lower implant costs, and low infection rates. Disadvantages include a 10% nonunion rate, adjacent joint degeneration, and loss of ankle motion, causing difficulties in activities like crouching, stair use, and uneven terrain navigation.<br /><br />TAR aims to preserve ankle motion and improve gait. Since the 1970s, implant designs have evolved from constrained, cemented components to modern, cementless, three-component systems (e.g., Hintegra, STAR, Salto). TAR use has surged (1500% increase from 2005-2014).<br /><br />Gait studies generally show neither TAR nor AA restores normal gait completely, but TAR patients tend to have better sagittal range of motion and gait symmetry. Functional and pain outcomes favor TAR in some studies but remain comparable overall. Both treatments provide pain relief and improved function compared to preoperative status.<br /><br />Adjacent joint arthritis develops after both AA and TAR, with no clear difference in progression rates at mid-term follow-up. Complication rates vary: TAR has lower overall complications (19.7% vs. 26.9% for AA) but higher revision rates; AA has higher reoperation rates mostly due to nonunion and wound issues.<br /><br />Survivorship of TAR components ranges from 70% to >90% at 5-10 years, though younger age and revisions are concerns. Obesity does not appear to increase failure rates.<br /><br />Indications for TAR include ankle OA with good alignment, healthy soft tissues, and older age with realistic expectations; contraindications include poor alignment, smoking, poor compliance, young age (<50), neuropathy, infection history, and poor vascular status.<br /><br />In conclusion, TAR is not inferior to AA and may offer superior function and gait, but patient selection and surgeon experience are critical. Long-term outcomes and implant comparisons require further study.

Keywords

Ankle osteoarthritis

Total ankle replacement

Ankle arthrodesis

Post-traumatic ankle OA

Gait analysis

Implant design evolution

Complication rates

Adjacent joint arthritis

Patient selection criteria

Surgical outcomes