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

INTRODUCTION

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.

STEP 1 PREOPERATIVE ASSESSMENT AND PLANNING: Conduct a thorough clinical and radiographic evaluation of the entire lower extremity.

STEP 2 SURGICAL ASSESSMENT: In the operating room, conduct a physical examination prior to and following ankle exposure to determine the ancillary procedures required.

STEP 3 MEDIAL SOFT-TISSUE RELEASE PES CAVUS CORRECTION: Proceed with tendon and soft-tissue release as needed to correct pes cavus deformity and improve range of motion.

STEP 4 CORRECTION OF VARUS TALAR DEFORMITY: Correct varus talar deformity via a standard resection of the ankle joint osteophytes, starting laterally and finishing medially.

STEP 5 POSTERIOR TIBIAL TENDON TRANSFER TO THE PERONEUS BREVIS: Consider transfer of the posterior tibial tendon to the peroneus brevis to help maintain correction of the varus deformity.

STEP 6 ANKLE REPLACEMENT: Once you determine that the talar varus is correctable and you have prepared the posterior tibial tendon for transfer, perform the total ankle replacement.

STEP 7 FOOT EVALUATION AND ANCILLARY PROCEDURES: 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.

RESULTS

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.