Total ankle replacement in the young patient

High physical demand and young age are currently considered contraindications to total ankle replacement. The number of Total Ankle Replacements (TAR) is constantly increasing, and better long-term outcomes are expected as result of the significant improvements of prosthetic designs and materials. A study of 100 uncemented STAR™ prostheses in patients under 50 years old, showed a survival rate of 75% at 6.8 years. Few studies have investigated the risk of failure rate in young patients in comparison to older group. A report of 780 TAR from the Swedish Ankle Register reported that patients with primary or post-traumatic osteoarthritis under 60 years of age had a 1.8 higher chance of revision compared to older patients. Better clinical results and higher satisfaction are reported in patients under the age of 50 with TAR compared to ankle arthrodesis. Ankle replacement has been traditionally reserved for patients over 50 years, and with low physical demand. Intriguingly, TAR indications in the recent years is constantly increasing among younger patients with several reports of implants under the fourth decade of life. Unfortunately, the outcome with the second-generation of prosthetic designs were mainly unsatisfactory. For this reason, studies based on third-generation’s TAR are advocated to better define the clinical outcome on younger patients. TAR represents a good option for young patients that have indication for fusion of the tibio-talar joint. The prevention of progressive degeneration of adjacent joints represent an important advantage compared to arthrodesis, although TAR presents a higher revision rate.