However, this resulted in inconsistent outcomes as well as high complication and revision rates, which was likely due to primitive design rationale, along with an insufficient understanding of the anatomy and biomechanics of the ankle. With implants, materials, designs, instruments, surgical approaches, and surgeon training evolution, it became possible to obtain better results in regard to pain control, patient satisfaction, functionality, and postoperative complications. The latest implant generation provides a large sizing variability, patient-specific implants, mobile bearings, and low bone resection with excellent early outcomes. Nowadays indications have been broadened, increasing implantation frequency, but still patient selection and careful evaluation is paramount
for a successful and satisfactory outcome.