Total ankle replacement (TAR) is the replacement of a damaged arthritic ankle joint with a prosthetic implant to eliminate the source of resultant pain and swelling. Historically, however, the ankle joint has been one of the most difficult joints to analyze and replicate for successful replacement due to its complex anatomy and multiplanar motion. Ankle fusion, the standard of care for end stage ankle arthritis, has excellent functional outcomes but results in loss of motion at the joint. TAR was first attempted in the 1970s and by the early 1990s, prosthesis designs more closely mirrored the natural anatomy of the ankle and TAR was no longer considered an experimental procedure. Although the outcomes of TAR have significantly improved over this short period of time, there are still many areas that warrant further investigation including (1) optimal patient selection, (2) number of prosthesis components, (3) bearing type, (4) revision rates and causes and (5) comprehensive finite element models (FEM) of the ankle. The main goal of this paper is to present a literature review on the background and evolution of TAR, the current state of practice and prosthesis types and challenges and directions for future improvement.
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