Tibiotalar Arthrodesis Conversion to Total Ankle Arthroplasty

JBJS Essential Surgical Techniques
Manuel J PellegriniMark E Easley

Abstract

Although conversion of the painful ankle arthrodesis to total ankle arthroplasty remains controversial, this surgical modality has satisfactorily expanded the treatment armamentarium for addressing this pathology. Preoperative preparation and planning is similar to that for a primary total ankle arthroplasty, and implants designed for primary arthroplasty can be used in most patients managed with conversion to total ankle replacement. Position the patient as for a primary total ankle replacement. Preserve exsanguination time by removing hardware prior to inflating the tourniquet. Recreate the native joint line, which can be relatively easy in selected patients and challenging in others. Set the optimal talar slope, which can be challenging, particularly when the ankle arthrodesis is malunited in equinus. Because the former medial and lateral articulations between the talus and the malleoli can be difficult to define, use careful surgical technique to avoid compromise of the malleoli and excessive talar resection. To avoid potential malleolar fractures, mobilize the ankle only after the prophylactic malleolar screws have been placed; the tibial and talar cuts, completed; the gutters, reestablished; all resected bone, removed; an...Continue Reading

References

Oct 6, 1997·Foot & Ankle International·S E LevineL C Schon
Feb 24, 2001·The Journal of Bone and Joint Surgery. American Volume·L M CoesterW Pontarelli
Oct 1, 2003·The Journal of Bone and Joint Surgery. British Volume·S FuchsC Chylarecki
Jul 9, 2004·Clinical Orthopaedics and Related Research·Justin GreisbergSigvard T Hansen
Feb 3, 2005·The Journal of Bone and Joint Surgery. American Volume·Dimitris KatsenisJohn E Herzenberg
Jun 4, 2008·The Journal of Bone and Joint Surgery. American Volume·Mark E EasleyJames A Nunley
Apr 3, 2009·The Journal of Bone and Joint Surgery. American Volume·Beat HintermannVictor Valderrabano
Jan 10, 2012·Foot & Ankle International·Roel P M HendrickxGino M M J Kerkhoffs
Dec 18, 2015·The Journal of Bone and Joint Surgery. American Volume·Manuel J PellegriniMark E Easley

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Citations

Apr 21, 2017·Clinical Orthopaedics and Related Research·Markus PreisAlexej Barg

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