Total ankle replacement in ankle arthritis with varus talar deformity: pathophysiology, evaluation, and management principles.

Varus malalignment of the ankle may be a misleading term. The isolated frontal plane deformity has been shown to be multiplanar in nature. Identifying this dominant feature of the condition and applying appropriate surgical principles to allow for complete correction of the deformity are critical to a successful outcome. The following 3 factors are key to an optimal surgical outcome from TAR with VMAA: (1) Obtaining a congruent ankle with sufficient ROM is a important before implantation of the arthroplasty prosthesis; (2) not all ankles are correctable; and (3) recognition both preoperatively and intraoperatively that a conversion of TAR to a fusion is sometimes the best course of action to achieve best results or patient satisfaction.