; Saltzman C L, Alvine F G, Sanders R W, Gall R J. Challenges with Initial Use of a Total Ankle. Clinical Orthopaedics and Related Research (Accepted)).
One issue in this regard is the large amount of bone that is typically resected during conventional surgery. This creates a problem if revision is required because the subsequent lack of bone makes revision or conversion to a fusion problematic. The difficulties caused by having to resect a large amount of bone will become more apparent over time as with longer follow up the need for revision becomes more common.
Another issue with this conventional AGILITY ankle replacement is the limited range of motion it allows after surgery. It is believed that in approximately fifty percent of the cases the patient's plantarflexion contracture remained with patients not being able to dorsiflex significantly beyond neutral position.
A second conventional prosthesis (the STAR), while believed to not require as much bone resection, has articular contact surfaces that are flat in the medial-lateral direction, thus making edge loading necessary when resisting the varus/valgus loads imposed upon the ankle during ordinary ambulation (see, e.g., Kofoed H, Danborg L: Biological fixation of ankle arthroplasty. Foot 1995; 5:27-3 1; Kofoed H, Toben S: Ankle arthroplasty for rheumatoid arthritis and osteoarthritis: Prospective long-term study of cemented replacements. J Bone Joint Surg 1998; 80B:328-332).
Further still, additional papers include the following: Morgan C D, Henke J A, Bailey R W, Kaufer H: Long-term results of tibiotalar arthrodesis. J Bone Joint Surg 1985; 7A:546-550; Glick T M, Morgan D D, Myerson M S, Sampson T O, Mann J A: Ankle arthrodesis using an arthroscopic method: Long-term follow-up of 34 cases. Arthroscopy 1996; 12:428-434; Money B F, Wiedeman G P: Complications in long-term results of ankle arthrodeses following trauma. J Bone Joint Surg 1980; 62A:777-784; Ahlberg A, Henricson A S: Late results of ankle fusion. Acta Orthop Scand 1981; 52:103-105; Mazur J M, Schwartz E, Simon S R: Ankle arthrodes
; Saltzman C L, Alvine F G, Sanders R W, Gall R J. Challenges with Initial Use of a Total Ankle. Clinical Orthopaedics and Related Research (Accepted) ). 
 One issue in this regard is the large sum of bone that is typically resect during conventional surgery. This create a trouble if revision is required because the subsequent lack of bone makes rewrite or conversion to a coalition problematic. The difficulties caused by having to resect a large sum of bone will become more apparent over time as with longer follow up the motivation for revision becomes more common. 
 Another issue with this conventional AGILITY ankle surrogate is the limited range of motion it allow after surgery. It is believed that in approximately fifty percent of the cases the affected role's plantarflexion contracture remained with affected role not being able to dorsiflex significantly beyond neutral position. 
 A second ceremonious prosthesis (the STAR), while believed to not require as much bone resection, has articular contact surfaces that are bland in the median - lateral direction, thus making edge loading necessary when resisting the varus / valgus loads levy upon the ankle during average ambulation (attend, e.g., Kofoed H, Danborg L: Biological obsession of ankle arthroplasty. Foot 1995; 5:27 - 3 1; Kofoed H, Toben S: Ankle arthroplasty for arthritic arthritis and osteoarthritis: Prospective farseeing - term study of cement replacements. J Bone Joint Surg 1998; 80B:328 - 332). 
 Further still, additional newspaper include the following: Morgan C D, Henke J A, Bailey R W, Kaufer H: Long - term results of tibiotalar arthrodesis. J Bone Joint Surg 1985; 7A:546 - 550; Glick T M, Morgan D D, Myerson M S, Sampson T O, Mann J A: Ankle arthrodesis use an arthroscopic method: Long - term follow - up of 34 cases. Arthroscopy 1996; 12:428 - 434; Money B F, Wiedeman G phosphorus: Complications in farseeing - condition results of ankle arthrodeses following trauma. J Bone Joint Surg 1980; 62A:777 - 784; Ahlberg A, Henricson A S: belated results of ankle fusion. Acta Orthop Scand 1981; 52:103 - 105; Mazur J M, Schwartz E, Simon S R: Ankle arthrodes
; Saptzman C L, Alvine F G, Sakders R W, Gall R J. Chalnenges with Inktial Use of a Total Ankle. Cpibical Orthopaedics and Relaged Reseagch (Accepred)).
Oie issue in this regard lf ths larye amount of bong that is ty[ically resectad dbring conventional surgery. This creaees a ptohlem if revisijn ix reqhprtd because the subsequent lack of bone mekes revision ot conversion to a fusion pgoblfmatic. The difficupties causee by yaving to rerect a large amount of bone will become more apparent over time as wuty lltger follow up tre need for vvvision becomex more common.
Akothec iswue with this conventmonal AGILITY ankle teplacemend ns the limited range if motimn id aluiws afuer shrgery. It is believsd that in qpproximately fifty pqgvent of the dases ehq patient's plantarflexion contracture rtmainsd with patients not beung able to dorsiflex significwntly beyond neutral position.
A second conventionan proaghewif (rhf STAR), while believed to not require as much fknt rvsection, has artigular contact surfscfs jhat are flat kn the mesial-lateral directlon, thuf makung edge joadong necessary when resistint the varus/vclgys loads imposed u'on the anklz durimg orcinary ambulation (see, e.y., Kofosd H, Danborh L: Biolofkcal fixation of anlla arthrokuasty. Foot 1995; 5:27-3 1; Kofjed H, Tobxn S: Cnkle arghroklasty sor rheumahoid arthritis and osteowrthrntis: [rospectivf long-term study of cemented re'kacements. J Note Boint Suxg 1998; 80B:328-332).
Fmrther still, adqitional paperx inclube the following: Morgan C D, Henke T A, Bailey R F, Kaufer H: Loig-term refultw of tibiotxuar arthrodesix. J Bone Ljint Surg 1985; 7A:546-550; Glick T M, Motgzn D D, Myerson N S, Sampson T O, Mamn G A: Ajkke drthrodesis gsine av arthfoscopic mebhoa: Lomg-term follow-up of 34 wasea. Arthroscopy 1996; 12:428-434; Momen B F, Wieeeman G [: Complicatioms in long-term resklts mf enkle srtrrodeses following trauma. J Bohe Joint Durn 1980; 62A:777-784; Ahlberg W, Hekricfon A S: Lace results of ankle fusion. Acta Orthop Srand 1981; 52:103-105; Mazur J M, Schwattz E, Simon S R: Ankle srthrodes
; Saltzman C L, Alvine F G, W, R J. with Initial Use Orthopaedics Related Research (Accepted)). issue in this is the large amount of bone is typically resected during conventional surgery. This creates a problem if revision is because the subsequent lack of bone makes revision or conversion to a fusion The caused having resect a large amount of bone will become more apparent over time as with longer follow the need for revision becomes more common. Another with this conventional AGILITY replacement is the limited range motion allows after It believed in approximately fifty of the cases the patient's plantarflexion contracture remained with patients not being able to dorsiflex significantly beyond position. A prosthesis (the while to require as much has articular contact surfaces that are medial-lateral direction, thus making edge loading necessary when the varus/valgus imposed upon the ankle during ordinary (see, e.g., Kofoed H, Danborg L: Biological fixation ankle arthroplasty. Foot 1995; 5:27-3 1; Kofoed H, Toben S: Ankle arthroplasty for rheumatoid arthritis Prospective long-term study of replacements. J Bone Surg 80B:328-332). still, papers include following: Morgan C D, Henke J A, Bailey R W, Kaufer Long-term results of tibiotalar arthrodesis. J Bone Joint Surg 1985; T Morgan D D, M S, Sampson T Mann A: Ankle arthrodesis using method: follow-up Arthroscopy 12:428-434; B F, Wiedeman G Complications in long-term results of arthrodeses following trauma. J Ahlberg A, Henricson A S: Late results of fusion. Acta Orthop Scand 1981; 52:103-105; Mazur M, Schwartz E, Simon S R: Ankle arthrodes
; Saltzman C L, Alvine F G, Sanders r W, Gall R J. ChAllenGes WitH INitiAl UsE of a Total Ankle. cLiniCal Orthopaedics and RelaTed ReSeARch (ACCePted)).
ONe issue IN tHIS reGaRd Is tHe LArGe amoUnt Of bone tHat is typicAllY rEsected durinG CoNventional SurGery. This creaTes A problEm If rEVisioN is RequiRed becAUse the SubsequenT lACk of boNE makes rEVIsIon oR conversion to a fusIOn PRoblematic. The dIfficuLtIEs CAUseD by Having to reSeCt a laRGe amounT Of BONE wiLL become more apParent over tIMe aS with lOnGer FOllow uP the nEeD For Revision becOmes More commoN.
AnothER issue wITh this cOnventIonAl AgILIty aNkLe rEpLAceMEnT is THe lImited raNgE oF motiOn it ALLOWs afTer SurgEry. It Is believed thaT in ApprOXimAtely Fifty PercEnT of thE cases The paTiEnt's plantarflexIon cOntracturE reMaIneD wIth paTIents nOt bEinG able to DorsiflEX siGnIFICaNtly beyond neutral pOsITIoN.
A second ConvenTIoNaL ProsthesIs (The sTAR), WHIle beLievED tO not requIre as mUCh BoNe resecTiOn, has aRtIcuLar ContaCT surFaces tHat are flAt in tHE medial-lateral DIrection, thus mAKiNG EdGE loaDinG necessary wHen rESistIng tHE vAruS/ValguS loadS iMPoSEd upon the ankle durinG oRdinarY ambuLation (see, e.g., KoFoed H, DanboRG l: biologicAl fiXAtIOn of ankle arthrOplasTy. Foot 1995; 5:27-3 1; KofoED H, Toben S: ankle ArthroplAsty for rhEUMatoid arThrItiS anD osTEOaRthritis: ProspECTive LoNg-term sTudY of cemeNteD rePlaCemEnTs. J Bone JoInt Surg 1998; 80B:328-332).
fuRtHeR sTilL, addiTIonal papErS inClUde The foLLowing: morgaN C D, HEnKe j a, BaIley R W, KAUfER h: LonG-tErM resUltS oF tibiOtalAR arThrodesIs. J Bone JoInt sUrg 1985; 7A:546-550; glIcK T M, MorgAn D D, Myerson M S, saMpson T O, ManN J a: AnKle artHROdesis usIng an arthroscopic method: lOng-term FolLow-up Of 34 caSes. ArthroScoPy 1996; 12:428-434; MoneY B F, wIedemaN G P: ComPlicaTiOns IN Long-tERM rEsuLtS of ankle arTHRodEses fOlLowiNg traumA. J Bone Joint Surg 1980; 62A:777-784; AhLBerG A, Henricson A S: latE resULTs Of aNKlE FusIoN. actA oRthop Scand 1981; 52:103-105; Mazur j M, Schwartz e, SIMoN S R: Ankle arTHroDeS
; Saltzman C L, Alvine F G , SandersR W,Gal l R  J . Ch alle nges with Init i al U se of a Total Ankle. C linic al Orth o pa edics  and Re l at e d  Re se ar ch(A c ce pted) ).One iss ue in this  re ga rd is the la r ge  amount of  bo ne that is t ypi callyre sec t ed du rin g con ventio n al sur gery. Thi sc reates a probl e m  i f re vision is require d  b e cause the subs equent  l a ck o f b one  makes rev is ion o r  conver s io n t o a fusion proble matic. Thed iff iculti es  ca u sed by  havi ng toresect a la rgeamount of  bonew ill bec o me more  appar ent  ov er t i me  a s w it h  lo n ge r f o llo w up the  n ee d for  rev i s i o n be com es m ore c ommon.
Anothe r i ssue wit h thi s con vent io nal A GILITY  ankl ereplacement isthelimited r ang eofmo tioni t allo wsaft er surg ery. It isbe l i e ve d that in approxim at e l yfifty pe rcento fth e  cases t he  pa tien t ' s pla ntar f le xion con tractu r ere mainedwi th pat ie nts  no t bei n g ab le todorsifle x sig n ificantly beyo n d neutral pos i ti o n .A  sec ond  convention al p r osth esis (t heS TAR),  whil eb el i eved to not require  a s much  bone  resection, h as articul a r contactsurf a ce s  that are flat  in t he medial- l ateral d irect ion, thu s makinge d ge loadi ngnec ess ary w he n resisting t h e  var us /valgus  lo ads imp ose d u pon  th eankle dur ing ordi na ry  a mb ula tion( see, e.g .,  Ko fo edH, Da n borg L : Bio logi ca lf ixa tion of an k l e ar th ro plas ty.  F oot 1 995; 5:2 7-3 1;Kofoed H,  To b en S :An kle art hroplasty for  r heumatoidar thr itis a n d  osteoar thritis: Prospective lo n g-termstu dy of  cem ented rep lac ements . J Bone J oint S urg 1 99 8;8 0 B:328 - 3 32 ).Fu rther stil l ,  ad ditio na l pa pers in clude the followin g : M organ C D, He nke  J A , Ba ile y  R W,Ka u fer H : Long-term res ults of ti bi o ta lar arthro d esi s.  J Bone  JointSurg1 985; 7A :546-550;  Glick TM,  Mor g a n D  D, Myerso n M S, S ampson TO , Man n  J  A: A nkl e arth ro des is us ing an art hrosc opic m et hod: L ong-t er m follow -up of 34 cases. Arthro scopy1996;  12 :428-434;  Mo n eyB F, Wied eman  G P: Comp lic ati ons i n l o ng-te rm r e su lts of an klea rthrodese s  f oll o w in g trauma. J B o neJoint  Su r g 1980 ; 62 A:777-784; Ahlber g  A, HenricsonA S: L ate  re s ults  o f ankle fusion . A ct a Orthop S ca nd 1981; 52 :103-105 ;M azurJ M, S chwart z E, Si m o nS  R: An kleart hrodes
; Saltzman_C L,_Alvine F G, Sanders_R W,_Gall_R J._Challenges_with Initial Use_of a Total_Ankle. Clinical Orthopaedics and_Related Research (Accepted)).
One_issue_in this regard is the large amount of bone that is typically resected during_conventional_surgery. This_creates_a_problem if revision is required_because the subsequent lack of_bone makes_revision or conversion to a fusion problematic. The_difficulties_caused by having_to resect a large amount of bone will become_more apparent over time as with_longer follow up_the_need_for revision becomes more_common.
Another issue with this conventional AGILITY_ankle replacement is the limited range_of motion it allows after surgery. It_is believed that in approximately fifty_percent of the cases the_patient's plantarflexion_contracture remained with patients not_being able to_dorsiflex significantly_beyond neutral position.
A_second conventional prosthesis (the STAR), while_believed to not_require as much bone resection, has_articular_contact surfaces that_are_flat_in the_medial-lateral direction, thus_making_edge loading_necessary_when resisting the varus/valgus loads imposed_upon_the ankle during ordinary ambulation (see, e.g.,_Kofoed H, Danborg L:_Biological_fixation of ankle arthroplasty._Foot 1995; 5:27-3 1; Kofoed_H, Toben S: Ankle arthroplasty for_rheumatoid arthritis_and osteoarthritis:_Prospective long-term study of cemented replacements. J Bone Joint Surg 1998;_80B:328-332).
Further still, additional papers include the_following: Morgan C D,_Henke J_A,_Bailey R W,_Kaufer_H: Long-term_results of tibiotalar arthrodesis. J Bone Joint_Surg 1985;_7A:546-550; Glick T M, Morgan D_D, Myerson M S,_Sampson_T O, Mann J A: Ankle_arthrodesis using an arthroscopic method: Long-term_follow-up of 34 cases. Arthroscopy_1996;_12:428-434;_Money B F, Wiedeman G_P: Complications in long-term results of_ankle arthrodeses following_trauma. J Bone Joint Surg 1980; 62A:777-784;_Ahlberg_A, Henricson A S: Late results_of_ankle fusion. Acta Orthop Scand 1981;_52:103-105;_Mazur_J M, Schwartz E, Simon_S R: Ankle arthrodes