Total Ankle Replacement: Back to the Future?

Hakon Kofoed

doi:10.4172/2329-910X.1000e102

ISSN: 2329-910X

Clinical Research on Foot & Ankle

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Total Ankle Replacement: Back to the Future?

Hakon Kofoed^*

Immediate past President, EFAS National Society, Denmark

*Corresponding Author:: Hakon Kofoed
Coast hospital Skodsborg, Denmark
E-mail: hakon.kofoed@gmail.com

Received Date: December 13, 2012; Accepted Date: December 26, 2012; Published Date: January 02, 2013

Citation: Kofoed H (2013) Total Ankle Replacement: Back to the Future? Clin Res Foot Ankle 1:e102. doi: 10.4172/2329-910X.1000e102

Copyright: © 2013 Kofoed H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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When total ankle replacement began in 1970 [1] the trend was soon followed by lots of others. All designs were two-component replacements with Fixed Bearings (FB) intended for fixation with bone cement. Already at 5-year follow-ups most designs were given up because of major problems with loosening. A few continued to solve the problems, and from the beginning of the 1980s the three component designs with Mobile Bearing (MB) were introduced [2,3]. With results superior to the former two-piece devices, a new era was started, and nearly all new designs from the late 1990s were three component devices, and intended for non-cemented use. The good survival rates have been confirmed also with these devices. They have all lend features from the two original designs [2-4], and much more attention has been paid to restoring a

gnment and stabi

ty of the ankle and hindfoot. Recently, for unclear reasons, the trend is to use two-piece (FB) designs again. Maybe this is inspired by the possibi

ty, on a 5-10 K basis, to introduce two-piece designs to the American market. These two piece designs are now hitting the market in numbers that equals the many designs in the 1970s. This is a cause of concern. The reason for introducing the MB designs was the inabi

ty for FB designs to find the correct position of the components. There is a widespread diversity not only in the normal anatomy and kinematics of the ankle, but especially in the pathological and degenerated ankles. The MB is a way to overcome this, and let the ankle find its best position by g

ding and rotation of the meniscus. Has this been in vain? In a recent lecture, it was claimed in a prospective study with short-term follow-up that the FB of prosthesis originally introduced as a MB design gave the better results in terms of optimal a

gnment, less radiolucent

nes, and better patient satisfaction [5]. It is astonishing when comparing the same groups’ former results with the MB design (survival rate at 5 years 95% [6]). Also it must be revealed how the optimal position of FB components is now feasible considering that the same a

gnment instruments were used. It remains to be proven for all the new FB total ankle designs that they are superior to - or at least equals - MB ankle replacements, so we do not end up with results

ke in the early 1970s.