Total Ankle Replacement
Patient Selection
Indications
End-stage degeneration of tibiotalar joint
Salvage of painful ankle arthrodesis
Traditionally reserved for patients older than 60 years with low physical demands (expanding with new implants)
Contraindications
Active infection
Severe soft-tissue compromise
Distal neuropathy
Diminished vascular supply
Relative contraindications
Coronal plane deformity > 15º
Obesity
Diabetes mellitus
History of ankle sepsis
Smoking
Preoperative Imaging
Figure 2Lateral dorsiflexion (A) and plantar flexion (B) radiographic views of the hindfoot in a patient with pes planus. These can help the surgeon determine correctability of the deformity and are useful for research.
Full-length, orthogonal, weight bearing of tibia and AP/lateral hindfoot views (Figure 1)
Consider maximal dorsiflexion and plantar flexion views as well as lateral obliques
Consider lateral dorsiflexion and plantar flexion views of hindfoot (Figure 2)
CT—evaluate bone quality, cyst, rotational alignment
MRI—assess osteonecrosis, ligament damage
Procedure
Room Setup
Supine position, bump under affected hip—ensure patella and second toe are pointing to ceiling
Pad contralateral fibula
Above-knee tourniquet as proximal as possible
Mini C-arm lateral to operative extremity
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