What role does ankle replacement play in managing pain and disability?

End-stage arthritis of the ankle causes significant pain and functional disability in affected individuals. Until the 1970s, arthrodesis was the standard treatment for symptomatic ankle arthritis. During the 1980s and 1990s, surgeons considered a number of different total ankle replacement designs. With improved understanding of ankle biomechanics and advances in implant design and surgical techniques, arthroplasty has become a reliable alternative to arthrodesis in some patients. Many factors must be considered when determining whether a patient is a good candidate for ankle replacement. The ideal patient is older than 50 and has a preserved range of motion, good ankle stability, and adequate bone quality. Absolute contraindications include active infection and peripheral vascular disease. A growing body of literature is providing information on implant survival, patient satisfaction, function, and complications. Possible complications include implant failure or aseptic loosening, polyethylene liner fracture, and deep infection. Evidence supports the need for careful patient selection, preoperative planning, surgeon experience, and familiarity with the chosen prosthesis. A nkle arthritis is a disabling condition that affects quality of life as much as arthritis of the hip or congestive heart failure. Arthrodesis has long been the mainstay of surgical treatment for when nonoperative treatment has failed. Today refined surgical techniques and improved biomechanical design have led to a significant increase in the volume of successful ankle replacements being done worldwide. Meanwhile, debate continues in the orthopaedic community about the ideal implant design, best surgical candidates, and relative contraindications to the procedure. Unlike primary osteoarthritis of the hip or knee, up to 80% of ankle arthritis is caused by trauma or altered ankle biomechanics and loading caused by recurrent ankle instability. In these instances, direct injury to cartilage or injury related to abnormal This article has been peer reviewed. Dr Apostle is an orthopaedic surgeon at Royal Columbian Hospital in New Westminster, BC, and a clinical assistant professor at the University of British Columbia.