This article presents an up-to-date summary of ankle joint biomechanics and various aspects relevant to the endoprosthetic replacement of this joint (specifically, the tibiotalar articulation) when indicated. These aspects are: the design requirements, choice of materials, and clinical studies involving various designs. The reasons for the disappointing in vivo performance of most ankle implants, to date, are suggested and areas for research and development, aimed at introducing a new generation of these implants, are identified.
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