Total Ankle Arthroplasties (TAA) Tibia Talk

by Vince Vacketta, DPM

Patient-reported outcomes (PROMs) and functional lifespan (survivorship) are the most common metrics used to evaluate arthroplasty procedures. Tibial fixation methods, such as pegs, posts, and stems, each have specific indications and unique experiences associated with their use.  

Low profile implants (pegs)

The Hospital for Special Surgery (HSS) conducted a study on 554 TAA. They reported a 3.8% revision rate for tibial lucency, with an average follow-up of 29 months. In comparison, another large study involving 504 Infinity implants, showed a 1.6% revision rate at two years. The HSS study suggested that poor seating might contribute to early lucency. Additionally, patients who underwent conversion from ankle fusion to TAA and male patients were identified as having a higher likelihood of developing lucency.

Implants with posts

In implants with post, the tibial stem is fixed and non-modular, taking the form of either a keel or a cylinder with various surfaces for bone ingrowth. This 2025 study evaluates the long-term outcomes of the Salto mobile bearing prosthesis, with an average follow-up of nine years. The study, which included 82 ankles fitted with the mobile bearing, reported a survivorship rate of 93.2% at 10 years.

Stemmed implants

Stemmed implants, such as the INBONE II, feature a modular stemmed component. Ashy, in a publication in Foot & Ankle International (FAI), reported on a systematic review of the INBONE II prosthesis. The study demonstrated a survivorship rate of 96.5% in a cohort of 406 ankles, with a mean follow-up period of just under four years.

The future

The battle lines for TAA design primarily focuses on tibial fixation. The key to informed decision-making lies in understanding the functional lifespan and longer-term data of these implants.