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Design Features of Current Total Ankle Replacements: Implants and Instrumentation

Dr. Cracchiolo is Director, Adult Foot and Ankle, and Professor, Department of Orthopaedic Surgery, UCLA Medical Center, Los Angeles, CA. Dr. DeOrio is Associate Professor, Division of Orthopaedic Surgery, Duke University Medical Center, Duke University, Durham, NC.

Dr. DeOrio or a member of his immediate family has received research or institutional support from Link Orthopaedics; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from Tornier, INBONE, Waldemar Link, and DePuy; and serves as a consultant to or is an employee of DePuy, Waldemar Link, Zimmer, and INBONE. Neither Dr. Cracchiolo nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Reprint requests: Dr. Cracchiolo, UCLA Medical Center, 10833 LeConte Ave, Rm 76-134CHS, Los Angeles, CA 90095-6902.

Development of total ankle replacements began nearly 40 years ago. The initial devices were cemented and highly constrained, and they eventually failed. These were followed by second-generation cementless ankle implants with a fixed (two-component design) or mobile (three-component design) polyethylene bearing. Currently, four ankle replacements are approved by the US Food and Drug Administration. These four—Agility, INBONE, Salto-Talaris, and Eclipse—are two-component designs; the Scandinavian Total Ankle Replacement, a three-part mobile-bearing design, has been recommended for approval by the FDA. It is anticipated to arrive in the US market in late 2008. Although interest in total ankle replacements is increasing, midterm clinical results to date are few and often have not been validated by independent practitioners. In addition, no level I or II studies have been published. Therefore, the design rationale for these implants and instruments should be carefully evaluated.