Of course other engineering aspects of the new designs made the prosthesis possible, such as making the implants more anatomical by realizing they needed to fulfil the 9-11 sq. Of the three designs, and I have significant experience with all of them, I use the Buechel-Pappas because of success percentages, less bone removal is needed to implant it and the design makes it possible to implant after excising a previously fused ankle. A functioning ankle joint is the result. It cannot be surprising that an anatomical ankle would take time to be reliable. Happily it is a reality in far less time than the hip or knee and can return patients with the severe debilitating disease that osteo and rheumatoid arthritis is, to full functioning individuals.
Patients walk, climb ladders and stairs, swim and play golf.
Provided, of course, they could play before their operation. If not, their new ankle joint permits learning. If there was a Nobel Prize for Medical Devices, Drs. Buechel and Pappas certainly deserve it. Against the extraordinary failure rates of 8 prostheses they endeavored to solve a problem when nearly all the orthopedic world espoused that the ankle joint cannot be replaced with a prosthesis.