Alloy Selection and Manufacturing Technologies for Total Ankle Arthroplasty: A Narrative Review.

Total ankle arthroplasty (TAA) has evolved significantly through advances in alloy selection and manufacturing technologies. This narrative review examines the metallurgical foundations of contemporary TAA implants, analyzing primary alloy systems and their mechanical properties. Cobalt-chromium alloys provide superior mechanical strength and durability but present metal ion release concerns, while titanium alloys (Ti6Al4V) optimize biocompatibility with elastic modulus values (101-113 GPa) closer to bone, despite tribological limitations. Novel β-titanium formulations (Ti-35Nb-7Zr-5Ta, Ti10Mo6Zr4Sn3Nb) eliminate toxic aluminum and vanadium components while achieving lower elastic modulus values (50-85 GPa) that better match cortical bone properties. Manufacturing has transitioned from traditional methods (investment casting, forging, CNC machining) toward additive manufacturing technologies. Selective laser melting and electron beam melting enable patient-specific geometries, controlled porosity, and optimized microstructures, though challenges remain with residual stresses, surface finish requirements, and post-processing needs. Emerging biodegradable materials, composite structures, and hybrid implant designs represent promising future directions for addressing current material limitations. This review provides evidence-based insights for alloy selection and manufacturing approaches, emphasizing the critical role of materials engineering in TAA implant performance and clinical outcomes.