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?? Close Window Top of Form A Home????|???? Help????|???? Contact Us Search ? Bottom of Form Clinical Policy Bulletin:Total Ankle Arthroplasty Number:?0645  Policy Aetna considers total ankle arthroplasty using?an FDA-cleared implant?medically necessary to replace an arthritic or severely?degenerated ankle in skeletally mature persons with moderate or severe pain with loss of ankle mobility and function due to osteoarthritis, post-traumatic arthritis and rheumatoid arthritis and who have failed at least 6 months of conservative management (including physical therapy, NSAIDs, and orthoses as indicated). Aetna considers total ankle arthroplasty?experimental and investigational for persons who have one or more of the following contraindications: Active or prior deep infection in the ankle joint or adjacent bones; Avascular necrosis of the talus; Charcot joint; Hindfoot or forefoot malalignment precluding plantigrade foot; Insufficient ligament support that cannot be repaired with soft tissue stabilization; Lower extremity vascular insufficiency; Neuromuscular disease resulting in lack of normal muscle function about the affected ankle; Peripheral neuropathy (may lead to Charcot joint of the affected ankle); Poor skin and soft tissue quality about the surgical site; Prior arthrodesis (fusion) at the ankle joint; Prior surgery or injury that has adversely affected ankle bone quality; Psychiatric problems that hinder adequate cooperation during perioperative period; Severe ankle deformity (e.g., severe varus or valgus deformithy) that would not normally be eligible for ankle arthroplasty; Severe osteoporosis, osteopenia or other conditions resulting in poor bone quality, as this may result in inadequate bony fixation; Significant malalignment of the knee joint; Skeletal maturity not yet reached; or Weight greater than 250 lbs. Total ankle arthroplasty is considered experimental and investigational for all other indications. Background Total ankle replacement is