Ankle and hindfoot reconstruction: What is new in ankle arthroplasty, allograft, and fusion

Purpose of review:. The advent of second-generation ankle arthroplasty systems has created a resurgence of their use to treat ankle arthritis. The treating surgeon is faced with the difficult choice of arthrodesis, arthroplasty, or allograft replacement to alleviate this condition. Recent findings: The literature supports the use of arthrodesis or arthroplasty in the treatment of arthritis. An analysis of the three most commonly used ankle implants (Agility, Buechel-Pappas, and S.T.A.R.) demonstrates satisfactory long-term survivorship and clinical results comparable with those of arthrodesis. These investigations also reveal a significant learning curve associated with ankle arthroplasty and allograft replacement. Summary: Recent research demonstrates that lasting patient satisfaction and pain relief are achievable with both ankle arthrodesis and ankle arthroplasty. The proven deterioration of adjacent joint surfaces after ankle arthrodesis may deter some from choosing this form of treatment. However, a number of authors have noted the difficult learning curve and subsequent poor initial results after ankle arthroplasty. Current literature does not support the clear advantage of one technique over the other, and thus the ultimate decision will be based on the surgeon's clinical judgment combined with the informed patient's preference. Additional studies directly comparing arthrodesis with arthroplasty in a matched patient population will help to refine the decision process and assist in suggesting the best treatment alternative.