History and Recent Development of Total Ankle Arthroplasty

Since the first total ankle arthroplasty (TAA) was performed in 1970, the number of TAA procedures for end-stage ankle osteoarthritis has gradually increased as an alternative to arthrodesis. There are two types of TAAs: mobile-bearing and fixed-bearing. Each has its own advantages and disadvantages, but both have evolved over time from the first generation to the fourth generation, with improvements addressing earlier limitations. Although fourth-generation TAAs were introduced to the market in the early 2010s and long-term outcomes remain uncertain, early reports have shown favorable survival rates of 92%-98% and significant improvements in functional and pain scores two years after surgery. The design of TAA devices has advanced through improvements in mechanisms, anatomical shapes, materials, and surgical approaches. These advancements have improved, and will continue to improve clinical outcomes and survival rates with each new generation.