Total ankle replacement

This issue of Acta Orthopaedica includes 3 articles on total ankle replacement (TAR), motivating this Guest Editorial (Nieuwe Weme et al. 2015, Kamrad et al. 2015, Horisberger et al. 2015). Patients with painful degenerative ankle disease often ask me: “Doctor, what would your own choice be, prosthesis or fusion?”. 10 years ago, with quite rough physical pursuits and as a surgeon encountering the considerable complications and reoperations after TAR, I would have chosen a fusion. After successful fusion, I would have less risk of persistent pain and no worry about loosening or additional surgical procedures. A risk of degenerative changes in the adjacent joints (Morrey and Wiedeman 1980, Coester et al. 2001, Fuchs et al. 2003) is—in my opinion—over-rated, and the association between degenerative changes in adjacent joints and clinical symptoms is uncertain (Morgan et al. 1985, Fuchs et al. 2003). Today, at almost 60 years of age, being a cyclist and not a runner any more (as I do have an ankle problem) and with myself today, as ankle surgeon, achieving correct placement, proper alignment, stability, and hardly any early perioperative complications in a high proportion of TAR cases, I would consider replacement performed in a highly specialized unit.