Rationale and historical evolution of total ankle arthroplasty

Résumé fourni par la source

Total ankle arthroplasty (TAA) has undergone significant evolution since its inception in the 1970s, transitioning from experimental approaches with high failure rates to more refined systems capable of replicating native ankle biomechanics. While ankle arthrodesis has traditionally been the gold standard for treating end-stage osteoarthritis, it compromises joint kinematics and predisposes adjacent joints to degeneration. Drawing inspiration from the success of hip and knee arthroplasty, early TAA designs attempted to restore motion but were limited by inadequate implant geometry, material performance, and surgical reproducibility. Advances in biomechanical understanding, imaging, and implant engineering have since enabled the development of second- and third-generation systems with improved outcomes. Key milestones include the transition from constrained two-component prostheses to semi- and fully mobile three-component designs, capable of accommodating complex rototranslational ankle motion. The Pipino-Calderale prosthesis, an early semi-fixed model designed to preserve the talar dome and instantaneous center of rotation (ICR), represented a pivotal effort to balance anatomical fidelity with mechanical stability. Building on this concept, the Vittore-Simone custom-made implant, modeled on 3D reconstructions of the contralateral ankle, demonstrated promising clinical results in a small series of patients, with significant improvements in pain and function over mid-term follow-up. Despite technical challenges and higher complication rates compared to other joint replacements, modern TAA continues to evolve, aided by improved biomaterials, surgical techniques, and personalized solutions. This review provides a historical and biomechanical synthesis of TAA development, highlighting how multidisciplinary advances have shaped current practice and may redefine ankle reconstruction in the future.

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