ABSTRACT
BACKGROUND: The early total ankle replacement has been abandoned for long times due to the insufficient understanding of the ankle joint biomechanics, higher implant failure rates and complications. With the updating of the design concept about ankle prosthesis, total ankle replacement surgery is now more and more popular among surgeons. At present, the three-component total ankle replacement prosthesis is considered to be more in line with the normal biomechanical requirements of the ankle joint, and has been gradually promoted for clinical application. OBJECTIVE: To understand the biomechanics of the ankle joint, summarize the design features of the three-component total ankle joint replacement prostheses, and summarize experience for further prosthetic design. METHODS: The first author used a computer to search CNKI and PubMed for the literature on total ankle replacement prostheses from inception to February 2020. The key words were “total ankle replacement prosthesis design, STAR prosthesis, HINTEGRA prosthesis, BOX prosthesis”. RESULTS AND CONCLUSION: (1) The STAR, HINTEGRA, and BOX prostheses have shown acceptable survival rates and clinical results in clinical applications; however, a large number of cases and long-term follow-up were also required. (2) The designs of the three kinds of total ankle replacement prostheses all focus on restoring the anatomy of the physiological ankle joint, reproducing the axis of motion of the ankle joint, being compatible with the geometry of the ligament, and reducing the mechanical alignment of the tissue around the ankle joint. (3) To achieve maximum ligament compatibility, the articular surface design of the prosthetic component must be two physiological anatomic shapes or two non-physiological anatomic shapes. (4) There is a significant difference between the shape of the Chinese ankle and that of Caucasian. We are looking forward to design and develop a more suitable prosthesis for Chinese peoples.