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Total Ankle Replacement Options Increase

Important considerations in total ankle replacement lack evidence basis

MONDAY, Sept. 8 (HealthDay News) -- While several implant options exist for total ankle replacement, there is little evidence to guide indications for total ankle replacement or choosing a total ankle replacement device, according to a report in the September issue of the Journal of the American Academy of Orthopaedic Surgeons.

Andrea Cracchiolo III, M.D., of the University of California Los Angeles Medical Center, and colleagues reviewed the literature regarding total ankle replacement and they report on the uncertainty surrounding indications for and choice of total ankle replacements.

While early generation total ankle replacements utilized cement, this did not allow significant mobility and was associated with a high failure rate, the authors note. Newer designs are cementless and significantly more mobile, although the most mobile models are not yet approved for use in the United States and most insurance carriers do not cover any total ankle replacement devices. In comparing and contrasting the advantages and disadvantages of each of the currently available models, the authors point out that, although total ankle replacements continue to attract interest, few clinical trial results have been validated by independent practitioners and no level I or II studies have been published to assist practitioners in the decision of which patients will benefit most from which device.

"In the history of total ankle replacements, a number of implants have been developed or are in development; some have never been used clinically," the authors write. "Guidelines for determining whether to perform a total ankle replacement and for choosing a specific implant remain unsettled."

One of the study authors has received financial support from companies developing total ankle replacements.

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