SPECIAL FOCUS: Problem Osteoporotic Fractures and OsteotomiesInsufficiency Fractures After Total Ankle ReplacementCastro, Michael D. DOAuthor Information University of Pennsylvania Health System, Pennsylvania Orthopaedic Foot and Ankle Surgeons, Philadelphia, PA Address correspondence and reprint requests to Michael D. Castro, DO, Pennsylvania Orthopaedic Foot and Ankle Surgeons, 230 West Washington Square, Philadelphia, PA 19106. E-mail: firstname.lastname@example.org. The author has a consulting agreement with DePuy Orthopaedics. Techniques in Foot & Ankle Surgery: March 2007 - Volume 6 - Issue 1 - p 15-21 doi: 10.1097/btf.0b013e318031f8a7 Buy Metrics Abstract Replacement arthroplasty of the ankle has emerged as a viable treatment option for end-stage degenerative joint disease. Bone quality and soft tissue balance have repeatedly been identified as paramount to the success of this procedure. These 2 issues demonstrate an intimate relationship. The native bony architecture is normally efficient in the axial transmission of ground reactive forces during weight-bearing gait. Alteration of the native anatomy after bone resection for prosthetic implant decreases its capacity to resist axial load. Osteoporosis and profound osteopenia are contraindicated in ankle replacement because of the potential for compressive and/or tensile failure of the bone. However, adhering to basic biomechanical principles can preserve the replacement in cases compromised by suboptimal bone quality. © 2007 Lippincott Williams & Wilkins, Inc.