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Cornelis Doets H. 1, Van Der Plaat L. W. 1, Nelissen R. G. H. H. 2
1 Department of Orthopedic Surgery Slotervaart Hospital Amsterdam, The Netherlands
2 Department of Orthopedic Surgery Leiden University Medical Center Leiden, The Netherlands
The aim of this review is to give a broad overview of all aspects related to the pathology and treatment of the arthritic ankle: kinematic aspects, disease-specific pathology, conservative and surgical treatment options, and on the surgical technique and outcome of modern total ankle arthroplasty (TAA). The methods that have been used were a detailed review of the English, and to a lesser extent non-English literature on the clinically relevant aspects of basic science, on the pathology of the arthritic ankle, the surgical treatment options, important design aspects of ankle prostheses and on the outcome of arthrodesis and TAA. The results led to the consideration that the kinematics of the ankle and tarsal joints are complex, closely linked, and have motion patterns around helical axes. Due to either acute or repetitive trauma or to inflammatory joint disease the ankle joint can undergo arthritic changes. For the surgical treatment of end-stage ankle arthritis 2 reconstructive procedures are available: arthrodesis and endoprosthetic replacement. Ankle arthrodesis healed in an optimal position has a good short-term clinical and functional outcome, but gait remains compromised. With longer follow-up there is an increased incidence of hindfoot arthritis. Constrained 2-component prostheses have an unacceptably high failure rate. Unconstrained mobile bearing prostheses allow for a more physiologic motion of the replaced ankle and have a good clinical outcome after midterm follow-up. In conclusion, TAA with use of a semiconstrained 2-component or an unconstrained 3-component mobile bearing prosthesis is a reliable alternative for ankle arthrodesis. Due to their unconstrained characteristics, mobile bearing prostheses are expected to give a good long-term result.