Ankle Arthroplasty

Ankle OA Pre ArthroplastyAnkle Arthroplasty APAnkle Arthroplasty Lateral




First generation (late 70s early 80s) 



- 80-85% Good / excellent in  short term

- severe osteolysis, aseptic loosening 90% 



- cemented 

- highly constrained

- considerable bone resection

- subsequent revision technically challenging


Second Generation (mid 80s onwards) 



- semiconstrained

- uncemented

- mobile and fixed bearing options

- bone preserving 




1.  Older patient with low demand


2.  Other joints arthritic

- degenerative SJT / midtarsal joint

- contra-lateral AKJ AO 

- previous triple arthrodesis


Absolute Contraindication


Infection (Acute or Chronic) 

Neuroarthropathies i.e Charcot 


Poor soft tissue envelope

Severe malalignment or instability that cant be corrected intraoperatively 

Major AVN affecting >1/3 of talus 


Relative Contra-indication


Dx - Posttraumatic worse outcomes than RA which has worse outcomes OA  


Age - Younger (worse outcomes in < 50 years) 


Ankle OA Post ORIF Ankle OA Arthroplasty APAnkle Arthroplasty post ORIF lateral


Minor Malalignment (>10 degrees of varus or valgus as compromises ligament stability) 




Stiffness (preoperative ROM = Postoperative ROM) 


Minor AVN talus


Second Generation Implants





- cobalt chrome tibia and talus

- titanium porous coating

- talus single keel

- tibial component two rounded keels

- mobile bearing poly


Anderson et al JBJS Am 2004

- 51 STAR

- 12 revisions

- 5 year survival 70%


Depuy Agility



- fusion of the distal tibio-fibular syndesmosis to support tibial component

- titanium tibial component with cobalt chrome talar resurfacing

- uncemented

- modular poly inserts into tibial component


Knecht et al JBJS Am 2004

- 69 followed clinically with 90% reporting decreased pain and satisfactory outcome

- 11% revision rate

- 76% demonstrated peri-implant radiolucency

- 20% progressive subtalar OA and 15% progressive TNJ OA




Anterior approach

- protect SPN

- between T ant and NV bundle

- remove anterior osteophytes


Tibial cut

- distal alignment jig

- resect few mm above eroded bone

- neutral cut

- must not cut medial or lateral malleolus


Talar dome

- resurfaced

- 3-4 mm removed




Haddad et al JBJS Am 2011

- systemic review

- similar satisfaction rates and and ankle scores in arthroplasty and arthrodesis groups

- 5 and 10 year survival of arthroplasty 77%

- 7% revision rate in arthroplasty (loosening and subsidence)

- 9% revision rate in arthrodesis (non union)


Liu et al, Int Orthop 2023

- Meta-analysis of 37 studies comparing arthrodesis and arthroplasty

- Arthroplasty PROMs > arthrodesis in the short term (<2y)

- Arthroplasty PROMs = arthrodesis in the medium term (2-5y)

- Arthrodesis PROMs > arthroplasty in the long term (>5y)






TAR LooseLoose TAR AP




Revision TAR APRevision TAR Lateral