There are considerable differences in the design and implantation technique of the current total ankle implants available in the United States, eg, mobile vs. fixed bearing, intramedullary vs. extramedullary guidance, anterior vs. lateral surgical approach, flat vs. curved bone cuts, natural articular design with minimal bone resection (Zimmer Trabecular Metal Total Ankle; Zimmer, Warsaw, Indiana) vs. larger implant construct with more bone resection (Inbone II; Figure 2). There is no evidence that one implant design is superior, and, as the authors conclude, “Direct comparisons between TAA [total ankle arthroplasty] implant systems are needed to determine what clinical benefits are achieved with each design and what contributes to these differences.”
Hsu AR, Anderson RB, Cohen BE. Total Ankle Arthroplasty. Am J Orthop. 2014;43(10):451-457.