A prosthesis for the ankle joint that I designed in 1973 was implanted
in fifty patients who otherwise would have required fusion of the ankle to
relieve severe pain. The design of the device allows about as much motion
as in the normal ankle. During implantation of the prosthesis the dome of
the talus is not resected and only one centimeter of the distal end of the
tibia is removed. If the prosthetic replacement is unsuccessful, fusion of
the ankle can more easily be achieved secondarily if it should become
necessary. Review of the cases of these fifty patients showed that the best
results were obtained in the patients with degenerative arthritis whose
ankles were stable and not unduly deformed. A few patients with rheumatoid
arthritis (four of ten) who were not on long-term steroid therapy also did
well. Contraindications revealed by my experience include avascular
necrosis of the talus, pseudarthrosis at the site of a previously attempted
ankle fusion, and conditions causing talar tilt of 20 degrees or more.