Alastair Younger, M.D., MB ChB FRCSC
Head, BC’s Foot and Ankle Clinic,
Providence Health Care,
And Clinical Instructor,
Division of Lower Limb Reconstruction and Oncology,
Department of Orthopaedics,
University of British Columbia,
Vancouver, BC

Introduction
Total ankle arthroplasty has had a poor reputation as the first generation of total ankle arthroplasties, such as the Mayo ankle, had poor short and long-term outcome much like similarly constrained designs for the knee, shoulder and elbow. More recent designs, such as the Agility, the STAR (Scandinavian Total Ankle Replacement), and the Buckel Pappas, all with semi-constrained bearing surfaces, are, up to seven years follow-up, clearly outperforming their predecessors, and are likely to outperform ankle fusion¹. The role of total ankle arthroplasty for the management of end stage arthritis of the ankle needs to be re-evaluated.  

Timothy R. Daniels, M.D., FRCSC
Toronto, ON

Life is motion - Motion is life is a motto adopted by the Canadian Orthopaedic Association to promote the activities of its members and to emphasize the importance of motion in the management of joint disease. Hip and knee arthroplasties are two of the most successful operations of the past century. For management of end-stage ankle arthritis, however, arthrodesis continues to be the mainstay of an orthopaedic practice. This is in part due to the early catastrophic failures of the 'first generation' ankle arthroplasties and the high patient satisfaction following an ankle arthrodesis. Despite the initial failures of ankle arthroplasties, several individuals remained committed to the possibilities of replacing the ankle joint and their persistence has resulted in the introduction of 'second generation' ankle implants^1,2. Preliminary clinical results are promising, giving rise to total ankle arthroplasty (TAR) as an option for managing end-stage arthritis. The recent developments have prompted the current debate in the COA Bulletin and my role is to defend arthrodesis of the ankle joint. No doubt, preservation of ankle motion is important; however, there are several functional and mechanical peculiarities of the foot that continue to make ankle arthrodesis a viable surgical alternative in the management of ankle arthritis and/or deformity.  

Elly Trepman, M.D.
Section of Orthopaedic Surgery,
Department of Surgery, University of Manitoba,
Winnipeg, MB

Gordon Dow, M.D., FRCPC
Section of Infectious Diseases, Department of Internal Medicine
The Moncton Hospital,
Moncton, NB