18 - Total Ankle Replacement

Abstract

Selection of the treatment approach for ankle arthritis should not be the surgeon’s decision alone. Many patients recognize the potential problems with ankle arthrodesis, the inherent stiffness, the limitation to certain activities, and in particular the likelihood of adjacent joint arthritis developing in the future. Within this group of patients, however, some prefer not to deal with potential for failure of an ankle replacement and want more predictability in the outcome and therefore select the arthrodesis. We outline all of the potential advantages and disadvantages, as well as the possibility of complications for each procedure; selection of the most appropriate procedure then becomes a joint decision that the patient and we make together. There are certain patients who should preferably not undergo an ankle replacement even if many of the other prerequisites are met, including those with severe osteopenia, severe avascular necrosis, those with neuropathy, patients who are young and very active, and those who have unrealistic expectations of the outcome of the procedure. On the other hand, there are certain indications for replacement that one can follow, and while not absolute, they are very helpful. These include the patient with bilateral ankle arthritis, the presence of a stiff subtalar joint, good range of motion in the ankle joint, good bone quality, normal alignment of the leg, and those individuals who are engaged in daily activities and who feel that they need more flexibility of the ankle, for example for dancing and yoga.