Survivorship of First-, Second-, and Third-Generation Total Ankle Replacement Systems

  • Thomas S. RoukisEmail author
  • Annette F. P. Bartel


It is commonly believed that the first-generation total ankle replacement (TAR) prostheses were far inferior to the second-generation prostheses which in turn were inferior to the current third-generation prostheses. As a result, TAR prosthesis longevity continues to be questioned and poorly understood especially the effect, if any, the specific design characteristics have had on effecting prosthesis survival. We evaluated the available literature to determine the survival rates for first-, second-, and third-generation TAR systems based on analysis of published Kaplan–Meier survival curve estimate data with time increments of 1 year each. Only first-, second-, or third-generation TAR systems with formal published Kaplan–Meier survival curves or reported values with censorship occurring at death or revision and a minimum of 5-year follow-up were included. From this analysis, it was determined that the survival rates for first-, second-, and third-generation TAR systems have only a small difference in survival between generations. We could not determine if this difference was in fact clinically significant. However, based on our findings, it appears that the commonly held belief that first-generation TAR prostheses were far inferior to the second-generation prostheses and that these were in turn inferior to the current third-generation TAR systems is not universally supported. This concept ought to be explored further especially regarding the effect that individual design features may have on long-term TAR survival.


Agility total ankle replacement system Ankle prosthesis Bologna–Oxford prosthesis Complications Foot and ankle surgery Kaplan–Meier survival estimate Hintegra total ankle prosthesis Mobility total ankle system Salto Mobile Version prosthesis Salto Talaris total ankle prosthesis Scandinavian total ankle replacement system Revision Salvage Total ankle arthroplasty 


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Orthopedic CenterGundersen Health SystemLa CrosseUSA
  2. 2.Gundersen Medical FoundationLa CrosseUSA

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