Total ankle replacement (TAR) for treating end-stage osteoarthritis of the ankle joint has been evolving since the early 1960s. Increased understanding of the biomechanics and kinematics of the foot and ankle, postoperative results of implant use, and advances in technology have led to improved implant designs and treatment outcomes. The current study reviews associated historical perspectives, kinematics, biomechanics, patient selection, imaging procedures, modern surgical techniques, postoperative complications, and comparison studies with arthrodesis to help evaluate TAR in successfully treating osteoarthritis of the ankle joint. Although arthrodesis remains the gold standard for treatment, findings of new studies have suggested that TAR may be comparable in outcomes, gait mechanics, and complications.

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