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.
Visit for more related articles at Clinical Research on Foot & Ankle
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 stabity 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 possibity, 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 inabity 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 gding 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 agnment, 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 agnment 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.
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