Surgical Technique for Total Ankle Arthroplasty in Ankles with Preoperative Coronal Plane Varus Deformity of 10° or Greater.

Abstract

Total ankle replacement for end-stage ankle arthritis with talar varus malalignment of ≥10° can achieve satisfactory outcomes in the ankle joint, and ≥10° of talar varus malalignment should not be considered a contraindication for surgery. Conduct a thorough clinical and radiographic evaluation of the entire lower extremity. In the operating room, conduct a physical examination prior to and following ankle exposure to determine the ancillary procedures required. Proceed with tendon and soft-tissue release as needed to correct pes cavus deformity and improve range of motion. Correct varus talar deformity via a standard resection of the ankle joint osteophytes, starting laterally and finishing medially. Consider transfer of the posterior tibial tendon to the peroneus brevis to help maintain correction of the varus deformity. Once you determine that the talar varus is correctable and you have prepared the posterior tibial tendon for transfer, perform the total ankle replacement. Evaluate the rest of the foot and perform any required ancillary procedures; most often a dorsiflexion osteotomy of the first metatarsal is necessary to correct forefoot valgus, which is commonly seen in forefoot-driven cavovarus deformities. Patients with preoperative coronal plane varus tibiotalar deformities of ≥10° who underwent total ankle replacement have shown significant improvement in clinical outcome scores at the time of mid-term follow-up.IndicationsContraindicationsPitfalls & Challenges.