History and evolution in total ankle arthroplasty

The current study provides an overview of history and evolution in total ankle arthroplasty. We conducted a comprehensive literature search without limitations to language. Information from any source, providing evidence of the use ankle of prostheses (e.g. biomechanical testing, cadaveric implantations or clinical use) was evaluated. Data regarding biomechanical concepts, design considerations, published results (patient numbers, surgical method, follow-up, complications and survival rates) were collected. Only level IV studies were found. Mobile-bearing prostheses are mainly used in Europe, and fixed-bearing implants are mainly used in the USA. The current designs' failure rate is 10-12% at similar to 5 years. Survival rates vary among different institutions. Increased surgeons' experience is associated with better outcomes. Biomechanical studies and review of previous implant failures has led to the development of a new generation of implants. Results show that ankle arthroplasty is a viable alternative for the management of ankle arthritis in selected patients.