Preoperative considerations in ankle replacement surgery.

Total ankle arthroplasty continues to evolve as a viable treatment option for end-stage ankle arthritis. Proper patient selection is a critical aspect of promoting a successful result. Acceptable results have been reported in older, low-demand, nonobese patients who have osteoarthritis or rheumatoid arthritis. A significant percentage of patients with end-stage ankle arthritis, however, are younger patients with posttraumatic arthritis. Considerable controversy surrounds the use of ankle replacement in younger, more physically active patients and in those with significant deformity in the ankle or hindfoot. These patients should be approached cautiously because the risks and complications are still significant. More studies must be completed and further developments must be made to maximize the longevity and functional results of total ankle arthroplasty in future designs and applications.