Abstract
This chapter describes the anatomy, pathology of the ankle and ankle replacements developed to treat pathological ankles. The history of three generations of ankle replacement designs, their evaluation in light of the material in Chapters I and 2 and the clinical performance of these designs are presented. The first and second generations had little success, except for the mobile bearing devices which were not available in the USA. This produced, in the United States, the incorrect perception that fusion was preferable to replacement. Unfortunately the FDA required a well controlled clinical trial for approval of a mobile bearing ankle device inhibiting the use of such devices in the USA until recently. Also presented is the design of a third generation ankle using the principles of the first three chapters. The design process of Chapter 3 was used for the development of an improved version of the LCS ankle. The B-P ankle replacement is the result. It is a mobile bearing device using ceramic coated titanium alloy for its metallic components. Early results were quite good. Unfortunately a major problem developed in long term use. Even though the wear in these devices is very low, this wear, nevertheless, produced destructive osteolytic cysts. This is a problem common to all current replacements. Perhaps improvement in manufacturing and/or materials can overcome this problem, but clearly more work and time is needed before a reliable, long term, ankle replacement becomes available.
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Buechel, F.F., Pappas, M.J. (2015). The Ankle. In: Principles of Human Joint Replacement. Springer, Cham. https://doi.org/10.1007/978-3-319-15311-7_4
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