Total Ankle Replacement Surgery
Approved by ACFAS Board of Directors, November 2023
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The American College of Foot and Ankle Surgeons (ACFAS) is a professional society of more than 8,000 foot and ankle surgeons. Founded in 1942, ACFAS seeks to promote the art and science of foot, ankle, and related lower extremity surgery, address the concerns of foot and ankle surgeons, advance and improve standards of education and surgical skill, and advance and advocate for the highest standards of patient care and safety.
ACFAS member physicians are doctors of podiatric medicine who are graduates of accredited U.S. podiatric medical schools. ACFAS members have completed surgical residency programs, and all Fellows of the College are certified by the American Board of Foot and Ankle Surgery (the surgical board of foot and ankle surgeons recognized by the Specialty Board Recognition Committee of the Council on Podiatric Medical Education). Many member physicians have additional fellowship training in various aspects of foot, ankle, and lower extremity surgery.
Osteoarthritis in advanced stages affects 1% of the adult population, with most cases resulting from previous ankle trauma.1,2 Historically, the prevailing option for patients with painful end-stage ankle arthritis has been ankle arthrodesis (joint fusion).3-6 While ankle arthrodesis can successfully relieve the pain within the joint, the resulting range of motion restriction can shift motion stresses to the adjacent joints, which in time may also become arthritic.3 In more recent years, total ankle replacement has been refined and is now a viable alternative to ankle arthrodesis with high patient acceptance in intermediate to long term data.4,7-10
Not every patient with end-stage arthritis of the ankle is a sound candidate for ankle replacement.5 Adjunctive procedures are often necessary as part of the surgical plan to ensure proper device function.11,12 A surgeon experienced in total ankle surgery can make this determination through careful history and physical evaluation.12,13 As with any total joint replacement, patients who are candidates for this procedure should be made aware of the expected outcomes and the possibility of revision surgery, as well as the risks, benefits, and alternative treatments.14,15
In the United States, total ankle replacement surgery is currently a safe and effective treatment option for appropriate patients with end stage ankle arthritis. Total ankle replacement surgery improves patient function, reduces pain, reduces energy expenditure in gait, and promotes improved quality of life.7,11,16-19
Patients should consider consulting with a surgeon who is board certified or board qualified in foot and ankle surgery with experience in total ankle replacement when considering this procedure.
1 Murray C, Marshall M, Rathod T, Bowen CJ, Menz HB, Roddy E. Population prevalence and distribution of ankle pain and symptomatic radiographic ankle osteoarthritis in community dwelling older adults: A systematic review and cross-sectional study. PLoS One. 2018 Apr 30;13(4):e0193662. doi: 10.1371/journal.pone.0193662. PMID: 29708977
2 Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B. Etiology of ankle osteoarthritis. Clin Orthop Relat Res. 2009 Jul;467(7):1800-6. doi: 10.1007/s11999-008-0543-6. Epub 2008 Oct 2. PMID: 18830791
3 Coester LM, Saltzman CL, Leupold J, Pontarelli W. Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am. 2001 Feb;83(2):219-28. doi: 10.2106/00004623-200102000-00009. PMID: 11216683.
4 Daniels TR, Younger AS, Penner M, Wing K, Dryden PJ, Wong H, Glazebrook M. Intermediate-term results of total ankle replacement and ankle arthrodesis: a COFAS multicenter study. J Bone Joint Surg Am. 2014 Jan 15;96(2):135-42. doi: 10.2106/JBJS.L.01597. PMID: 24430413.
5 Flavin R, Coleman SC, Tenenbaum S, Brodsky JW. Comparison of gait after total ankle arthroplasty and ankle arthrodesis. Foot Ankle Int. 2013 Oct;34(10):1340-8. doi: 10.1177/1071100713490675. Epub 2013 May 13. PMID: 23669163.
6 Lawton CD, Butler BA, Dekker RG 2nd, Prescott A, Kadakia AR. Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade. J Orthop Surg Res. 2017 May 18;12(1):76. doi: 10.1186/s13018-017-0576-1. PMID: 28521779; PMCID: PMC5437567.
7 Zaidi R, Cro S, Gurusamy K, Siva N, Macgregor A, Henricson A, Goldberg A. The outcome of total ankle replacement: a systematic review and meta-analysis. Bone Joint J. 2013 Nov;95-B(11):1500-7. doi: 10.1302/0301-620X.95B11.31633. PMID: 24151270.
8 Nunley JA, Caputo AM, Easley ME, Cook C. Intermediate to long-term outcomes of the STAR Total Ankle Replacement: the patient perspective. J Bone Joint Surg Am. 2012 Jan 4;94(1):43-8. doi: 10.2106/JBJS.J.01613. PMID: 22218381.
9 Haddad SL, Coetzee JC, Estok R, Fahrbach K, Banel D, Nalysnyk L. Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature. J Bone Joint Surg Am. 2007 Sep;89(9):1899-905. doi: 10.2106/JBJS.F.01149. PMID: 17768184.
10 Koivu H, Kohonen I, Mattila K, Loyttyniemi E, Tiusanen H. Long-term Results of Scandinavian Total Ankle Replacement. Foot Ankle Int. 2017 Jul;38(7):723-731. doi: 10.1177/1071100717698695. Epub 2017 May 23. PMID: 28535724.
11 Saltzman CL, Mann RA, Ahrens JE, Amendola A, Anderson RB, Berlet GC, Brodsky JW, Chou LB, Clanton TO, Deland JT, Deorio JK, Horton GA, Lee TH, Mann JA, Nunley JA, Thordarson DB, Walling AK, Wapner KL, Coughlin MJ. Prospective controlled trial of STAR total ankle replacement versus ankle fusion: initial results. Foot Ankle Int. 2009 Jul;30(7):579-96. doi: 10.3113/FAI.2009.0579. PMID: 19589303.
12 Schuberth JM, Patel S, Zarutsky E. Perioperative complications of the Agility total ankle replacement in 50 initial, consecutive cases. J Foot Ankle Surg. 2006 May-Jun;45(3):139-46. doi: 10.1053/j.jfas.2006.02.013. PMID: 16651192.
13 Steck JK, Anderson JB. Total ankle arthroplasty: indications and avoiding complications. Clin Podiatr Med Surg. 2009 Apr;26(2):303-24. doi: 10.1016/j.cpm.2009.02.001. PMID: 19389601.
14 Jastifer JR, Coughlin MJ. Long-term follow-up of mobile bearing total ankle arthroplasty in the United States. Foot Ankle Int. 2015 Feb;36(2):143-50. doi: 10.1177/1071100714550654. Epub 2014 Sep 8. PMID: 25201330.
15 SooHoo NF, Zingmond DS, Ko CY. Comparison of reoperation rates following ankle arthrodesis and total ankle arthroplasty. J Bone Joint Surg Am. 2007 Oct;89(10):2143-9. doi: 10.2106/JBJS.F.01611. PMID: 17908889.
16 Shih CL, Chen SJ, Huang PJ. Clinical Outcomes of Total Ankle Arthroplasty Versus Ankle Arthrodesis for the Treatment of End-Stage Ankle Arthritis in the Last Decade: a Systematic Review and Meta-analysis. J Foot Ankle Surg. 2020 Sep-Oct;59(5):1032-1039. doi: 10.1053/j.jfas.2019.10.008. Epub 2020 Jul 21. PMID: 32709528.
17 Detrembleur C, Leemrijse T. The effects of total ankle replacement on gait disability: analysis of energetic and mechanical variables. Gait Posture. 2009 Feb;29(2):270-4. doi: 10.1016/j.gaitpost.2008.09.009. Epub 2008 Nov 1. PMID: 18977660.
18 Hahn ME, Wright ES, Segal AD, Orendurff MS, Ledoux WR, Sangeorzan BJ. Comparative gait analysis of ankle arthrodesis and arthroplasty: initial findings of a prospective study. Foot Ankle Int. 2012 Apr;33(4):282-9. doi: 10.3113/FAI.2012.0282. PMID: 22735200.
19 Queen RM, De Biassio JC, Butler RJ, DeOrio JK, Easley ME, Nunley JA. J. Leonard Goldner Award 2011: changes in pain, function, and gait mechanics two years following total ankle arthroplasty performed with two modern fixed-bearing prostheses. Foot Ankle Int. 2012 Jul;33(7):535-42. doi: 10.3113/FAI.2012.0535. PMID: 22835389.