Total ankle replacement

Open Access-This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited. This issue of Acta Orthopaedica includes 3 articles on total ankle replacement (TAR), motivating this Guest Editorial (Nieuwe Weme et al. 2015, Kamrad et al. 2015, Horisberger et al. 2015). Patients with painful degenerative ankle disease often ask me: " Doctor, what would your own choice be, prosthesis or fusion? ". 10 years ago, with quite rough physical pursuits and as a surgeon encountering the considerable complications and reoperations after TAR, I would have chosen a fusion. After successful fusion, I would have less risk of persistent pain and no worry about loosening or additional surgical procedures. A risk of degenerative changes in the adjacent joints (Morrey and Wiedeman 1980, Coester et al. 2001, Fuchs et al. 2003) is—in my opinion—over-rated, and the association between degenerative changes in adjacent joints and clinical symptoms is uncertain (Morgan et al. 1985, Fuchs et al. 2003). Today, at almost 60 years of age, being a cyclist and not a runner any more (as I do have an ankle problem) and with myself today, as ankle surgeon, achieving correct placement, proper alignment, stability, and hardly any early perioperative complications in a high proportion of TAR cases, I would consider replacement performed in a highly specialized unit. Improving surgical techniques and expanding the indication for TAR There is no doubt that from a surgical, technical point of view progress is being made. Not so long ago, a preoperative frontal plane deformity would have been considered a risk for failure of TAR (Doets et al. 2006, Henricson and Ågren 2007, Wood et al. 2008). However, after correcting hindfoot deformity peroperatively, or before or after the index procedure, Hobson et al (2009) found similar survival, postoperative motion, and complications between a preoperative hindfoot deformity of up to 10° (91 ankles) and a deformity group of 11° to 30° (32 ankles). Nieuve Weme et al. (2015) compared the medium-term results of TAR between a group of 50 patients with arthritis secondary to an intra-or juxta-articular fracture and a group of 40 patients with ligamentous posttrau-matic arthritis secondary to a severe ankle sprain or chronic lateral instability. The latter group was characterized by instability and a varus deformity, addressed by medial soft tissue release or medial malleolar osteotomy. …