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Michael J. Coughlin, MD

Michael J. Coughlin graduated from the University of Oregon Medical School in 1974 and did his orthopaedic training at the University of California-San Francisco and a foot and ankle fellowship  in 1978. Following this, he returned to orthopaedic foot and ankle practice in Boise, Idaho.  He was the youngest President of the American Orthopaedic Foot and Ankle Society, serving from 1990 – 1991. He was also president of the International Federation of Foot and Ankle Society’s from 2002-2005.  He is the co-editor of Surgery of the Foot and Ankle 9th Edition and edited three  prior editions.  It is considered “the bible” of foot and ankle surgery in the US.  He has published over 200 scientific articles and over 500 scientific presentations on issues relating to the foot and ankle. He is a Professor of Orthopedic Surgery at University of California San Francisco; he is the Director of the Idaho Orthopedic Foot and Ankle Fellowship and practices orthopedic foot and ankle surgery in Boise, Idaho at the St Alphonsus Coughlin Foot and Ankle Clinic. He has been a consultant for the NFL for 9 years, and Co-chair of the Foot and Ankle subcommittee for Health and Safety for 7 years. He consults for the Green Bay Packers, and examines for them at the NFL combine yearly.  He also consults for the Oregon Ducks and Boise State Broncos. 

“Total ankle design: what is being done in America and around the world”


Total ankle replacement has evolved substantially since first performed in 1970 (Lord and Marotte).  Early attempts in the US and Europe centered around cemented prostheses, which by design, were non-anatomic, and had little regard for soft tissue balancing. After a hiatus of two decades, improved un-cemented designs in Asia, Europe and the U.S. dramatically changed the orthopaedic landscape, and provided a real alternative to arthrodesis for end stage ankle arthritis.


The introduction of three part metal/polyethylene prostheses by Buechel (U.S.), Kofoed (Denmark), and ceramic designs by Takakura (Japan) lead to a plethora of new and innovative designs around the world.


The popularity of a mobile bearing total ankles in Europe is contrasted with the difficulty of introducing a Class-3 (new) device in the U.S.  At this time, the Scandinavian (STAR) (Mann, Coughlin) total ankle is the only three part ankle permitted by the FDA. Several three part total ankles from Europe have been modified to two part prostheses in order to circumvent the rigorous investigative process required by the FDA. Several two-part ankles have been authorized for implantation using the 510-k process.

While early results with first generation ankle replacements demonstrated high failure rates, current U.S. reports using uncemented with titanium spray surfaces for bony ingrowth  have noted to have >80% retention rates at ten years or more follow-up. Total ankle replacement is considered now to be a realistic alternative to ankle arthrodesis.


1. Lord G , Marotte JH : [Total ankle prosthesis. Technic and 1st results. Apropos of 12 cases] , Rev Chir Orthop Reparatrice Appar Mot 59 : 139 – 151 , 1973

2. Buechel FF Sr , Buechel FF Jr , Pappas MJ : Ten-year evaluation of cementless Buechel-Pappas meniscal bearing total anklereplacement , Foot Ankle Int 24 : 462 – 472 , 2003

3. Kofoed H : Cylindrical cemented ankle arthroplasty: a prospective series with long-term follow-up , Foot Ankle Int 16 : 474 – 479 , 1995 .

4. Kofoed H , Sorensen TS : Ankle arthroplasty for rheumatoid arthritis and osteoarthritis: prospective long-term study of cemented replacements , J Bone Joint Surg Br 80 : 328 – 332 , 1998 .

5. Takakura Y , Tanaka Y , Kumai T , et al : Ankle arthroplasty using three generations of metal and ceramic prostheses , Clin Orthop Relat Res 424 : 130 – 136 , 2004

6. Takakura Y , Tanaka Y , Sugimoto K , et al : Ankle arthroplasty. A comparative study of cemented metal and uncemented ceramic

prostheses , Clin Orthop Relat Res 252 : 209 – 216 , 1990

7. Mann JA , Mann RA , Horton E : STAR ankle: Long-term results ,

Foot Ankle Int 32 : 473 – 484 , 2011

8. Jastifer JR, Coughlin MJ: Long-term follow-up of mobile bearing total ankle arthroplasty in the United States. Foot Ankle Int 36(2): 143-150, 2015

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