, Volume 29, Issue 3, pp 225–230 | Cite as

Nuove prospettive nel trattamento dell’artrosi di caviglia: la sostituzione protesica

  • Francesco Malerba
  • Nicolò Martinelli
  • Giovanni Romeo

New perspectives in the management of ankle osteoarthritis: total ankle replacement


Recent advances in prosthesis design, combined with a better understanding of ligamentous balancing and component alignment have renewed interest in total ankle replacement (TAR) as an alternative to ankle arthrodesis in selected patients. The first generation of total ankle prosthesis failed owing to not congruent and unstable designs. Earlier studies for total ankle replacement found excellent or good results in patients who received a newer generation ankle device compared with patients who underwent TAR with previous implants or ankle fusion. Longer follow-up and randomized controlled studies are necessary, but total ankle arthroplasty has become a viable option for surgical treatment of ankle arthritis.


Conflitto di interesse

Gli autori Francesco Malerba, Nicolò Martinelli e Giovanni Romeo dichiarano di non avere alcun conflitto di interesse.

Consenso informato e conformità agli standard etici

Tutte le procedure descritte nello studio e che hanno coinvolto esseri umani sono state attuate in conformità alle norme etiche stabilite dalla dichiarazione di Helsinki del 1975 e successive modifiche. Il consenso informato è stato ottenuto da tutti i pazienti inclusi nello studio.

Human and Animal Rights

L’articolo non contiene alcuno studio eseguito su esseri umani e su animali da parte dell’autore.


  1. 1.
    Kujala UM, Kaprio J, Sarna S (1994) Osteoarthritis of weight bearing joints of lower limbs in former élite male athletes. BMJ 308:231–234 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Joseph RM (2009) Osteoarthritis of the ankle: bridging concepts in basic science with clinical care. Clin Podiatr Med Surg 26:169–184 CrossRefPubMedGoogle Scholar
  3. 3.
    Saltzman CL, Zimmerman MB, O’Rourke M et al. (2006) Impact of comorbidities on the measurement of health in patients with ankle osteoarthritis. J Bone Jt Surg, Am 88:2366–2372 CrossRefGoogle Scholar
  4. 4.
    Lee WC, Moon JS, Lee HS, Lee K (2011) Alignment of ankle and hindfoot in early stage ankle osteoarthritis. Foot Ankle Int 32:693–699 CrossRefPubMedGoogle Scholar
  5. 5.
    Coester LM, Saltzman CL, Leupold J, Pontarelli W (2001) Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Jt Surg, Am 83:219–228 CrossRefGoogle Scholar
  6. 6.
    Hendrickx RP, Stufkens SA, de Bruijn EE et al. (2011) Medium- to long-term outcome of ankle arthrodesis. Foot Ankle Int 32:940–947 CrossRefPubMedGoogle Scholar
  7. 7.
    Gougoulias NE, Khanna A, Maffulli N (2009) History and evolution in total ankle arthroplasty. Br Med Bull 89:111–151 CrossRefPubMedGoogle Scholar
  8. 8.
    Bianchi A, Martinelli N, Sartorelli E, Malerba F (2012) The Bologna-Oxford total ankle replacement: a mid-term follow-up study. J Bone Jt Surg, Br 94:793–798 CrossRefGoogle Scholar
  9. 9.
    Kwon DG, Chung CY, Park MS et al. (2011) Arthroplasty versus arthrodesis for end-stage ankle arthritis: decision analysis using Markov model. Int Orthop 35:1647–1653 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Esparragoza L, Vidal C, Vaquero J (2011) Comparative study of the quality of life between arthrodesis and total arthroplasty substitution of the ankle. J Foot Ankle Surg 50:383–387 CrossRefPubMedGoogle Scholar
  11. 11.
    Krause FG, Windolf M, Bora B et al. (2011) Impact of complications in total ankle replacement and ankle arthrodesis analyzed with a validated outcome measurement. J Bone Jt Surg, Am 93:830–839 CrossRefGoogle Scholar
  12. 12.
    Vickerstaff JA, Miles AW, Cunningham JL (2007) A brief history of total ankle replacement and a review of the current status. Med Eng Phys 29:1056–1064 CrossRefPubMedGoogle Scholar
  13. 13.
    Piriou P, Culpan P, Mullins M et al. (2008) Ankle replacement versus arthrodesis: a comparative gait analysis study. Foot Ankle Int 29:3–9 CrossRefPubMedGoogle Scholar
  14. 14.
    Doets HC, van Middelkoop M, Houdijk H et al. (2007) Gait analysis after successful mobile bearing total ankle replacement. Foot Ankle Int 28:313–322 CrossRefPubMedGoogle Scholar
  15. 15.
    Valderrabano V, Hintermann B, Nigg BM et al. (2003) Kinematic changes after fusion and total replacement of the ankle: part 1: Range of motion. Foot Ankle Int 24:881–887 CrossRefPubMedGoogle Scholar
  16. 16.
    Valderrabano V, Hintermann B, Nigg BM et al. (2003) Kinematic changes after fusion and total replacement of the ankle: part 2: Movement transfer. Foot Ankle Int 24:888–896 CrossRefPubMedGoogle Scholar
  17. 17.
    Valderrabano V, Hintermann B, Nigg BM et al. (2003) Kinematic changes after fusion and total replacement of the ankle: part 3: Talar movement. Foot Ankle Int 24:897–900 CrossRefPubMedGoogle Scholar
  18. 18.
    Krause FG, Schmid T (2012) Ankle arthrodesis versus total ankle replacement: how do I decide? Foot Ankle Clin 17:529–543 CrossRefPubMedGoogle Scholar
  19. 19.
    Barg A, Knupp M, Hintermann B (2010) Simultaneous bilateral versus unilateral total ankle replacement: a patient-based comparison of pain relief, quality of life and functional outcome. J Bone Jt Surg, Br 92:1659–1663 CrossRefGoogle Scholar
  20. 20.
    Barg A, Elsner A, Hefti D, Hintermann B (2010) Haemophilic arthropathy of the ankle treated by total ankle replacement: a case series. Haemophilia 16:647–655 PubMedGoogle Scholar
  21. 21.
    Barg A, Elsner A, Hefti D, Hintermann B (2011) Total ankle arthroplasty in patients with hereditary hemochromatosis. Clin Orthop Relat Res 469:1427–1435 CrossRefPubMedGoogle Scholar
  22. 22.
    Bouchard M, Amin A, Pinsker E et al. (2015) The impact of obesity on the outcome of total ankle replacement. J Bone Jt Surg, Am 97:904–910 CrossRefGoogle Scholar
  23. 23.
    Kofoed H, Lundberg-Jensen A (1999) Ankle arthroplasty in patients younger and older than 50 years: a prospective series with long-term follow-up. Foot Ankle Int 20:501–506 CrossRefPubMedGoogle Scholar
  24. 24.
    Park JS, Mroczek KJ (2011) Total ankle arthroplasty. Bull NYU Hosp Jt Dis 69:27–35 PubMedGoogle Scholar
  25. 25.
    Demetracopoulos CA, Adams SB Jr, Queen RM et al. (2015) Effect of age on outcomes in total ankle arthroplasty. Foot Ankle Int 36:871–880 CrossRefPubMedGoogle Scholar
  26. 26.
    Lord G, Marotte JH (1980) Total ankle replacement (author’s transl). Rev Chir Orthop Repar Appar Mot 66:527–530 Google Scholar
  27. 27.
    Stauffer RN, Segal NM (1981) Total ankle arthroplasty: four years’ experience. Clin Orthop Relat Res 160:217–221 Google Scholar
  28. 28.
    Kitaoka HB, Patzer GL, Ilstrup DM, Wallrichs SL (1994) Survivorship analysis of the Mayo total ankle arthroplasty. J Bone Jt Surg, Am 76:974–979 CrossRefGoogle Scholar
  29. 29.
    Pappas M, Buechel FF, DePalma AF (1976) Cylindrical total ankle joint replacement: surgical and biomechanical rationale. Clin Orthop Relat Res 118:82–92 Google Scholar
  30. 30.
    Kofoed H (2004) Scandinavian Total Ankle Replacement (STAR). Clin Orthop Relat Res 424:73–79 CrossRefGoogle Scholar
  31. 31.
    Alvine FG (1991) Total ankle arthroplasty: new concepts and approaches. Contemp Orthop 22:397–403 PubMedGoogle Scholar
  32. 32.
    Takakura Y, Tanaka Y, Sugimoto K et al. (1990) Ankle arthroplasty. A comparative study of cemented metal and uncemented ceramic prostheses. Clin Orthop Relat Res 252:209–216 Google Scholar
  33. 33.
    Rippstein PF (2002) Clinical experiences with three different designs of ankle prostheses. Foot Ankle Clin 7:817–831 CrossRefPubMedGoogle Scholar
  34. 34.
    Hintermann B, Valderrabano V (2003) Total ankle replacement. Foot Ankle Clin 8:375–405 CrossRefPubMedGoogle Scholar
  35. 35.
    Brigido SA, Mulhern JL, Wobst GM, Protzman NM (2015) Preoperative and postoperative range of motion: a retrospective comparison of two total ankle replacement systems. J Foot Ankle Surg. doi: 10.1053/j.jfas.2014.12.036 Google Scholar
  36. 36.
    Yu JJ, Sheskier S (2014) Total ankle replacement. Evolution of the technology and future applications. Bull Hosp Jt Dis 72:120–128 Google Scholar
  37. 37.
    Zaidi R, Cro S, Gurusamy K et al. (2013) The outcome of total ankle replacement: a systematic review and meta-analysis. Bone Jt J 95:1500–1507 CrossRefGoogle Scholar
  38. 38.
    Saltzman CL, Mann RA, Ahrens JE et al. (2009) Prospective controlled trial of STAR total ankle replacement versus ankle fusion: initial results. Foot Ankle Int 30:579–596 CrossRefPubMedGoogle Scholar
  39. 39.
    Haddad SL, Coetzee JC, Estok R et al. (2007) Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature. J Bone Jt Surg, Am 89:1899–1905 Google Scholar
  40. 40.
    Glazebrook MA, Arsenault K, Dunbar M (2009) Evidence-based classification of complications in total ankle arthroplasty. Foot Ankle Int 30:945–949 CrossRefPubMedGoogle Scholar
  41. 41.
    Rippstein PF, Huber M, Naal FD (2012) Management of specific complications related to total ankle arthroplasty. Foot Ankle Clin 17:707–717 CrossRefPubMedGoogle Scholar
  42. 42.
    Rahm S, Klammer G, Benninger E et al. (2015) Inferior results of salvage arthrodesis after failed ankle replacement compared to primary arthrodesis. Foot Ankle Int 36:349–359 CrossRefPubMedGoogle Scholar
  43. 43.
    Myerson MS, Won HY (2008) Primary and revision total ankle replacement using custom-designed prostheses. Foot Ankle Clin 13:521–538 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2015

Authors and Affiliations

  • Francesco Malerba
    • 1
  • Nicolò Martinelli
    • 1
  • Giovanni Romeo
    • 1
  1. 1.Chirurgia della caviglia e del piedeIRCCS Istituto Ortopedico GaleazziMilanoItalia

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