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Total Ankle Replacement With Advanced Varus and Valgus Deformities

Saito, Guilherme H., MD; Sanders, Austin E., BA; Demetracopoulos, Constantine A., MD

Techniques in Foot & Ankle Surgery: June 2018 - Volume 17 - Issue 2 - p 43–50
doi: 10.1097/BTF.0000000000000198
Special Focus: Challenges in Total Ankle Arthroplasty

Severe deformity in patients with end-stage ankle arthritis has long been considered a relative contraindication for total ankle replacement. However, advancements in surgical techniques and a better understanding of the importance of correcting foot deformity in conjunction with ankle deformity have led to satisfactory outcomes in this group of patients. Management of these deformities is contingent upon identifying all sources of deformities in the limb both proximal and distal, addressing the deformity in a systematic manner, achieving ligamentous stability at the ankle, and assuring dynamic stability with proper soft tissue balancing procedures. The authors discuss the main challenges while addressing ankles with severe deformities, and describe the preferred techniques for correction of the advanced varus and valgus ankle deformities.

Level of Evidence: Diagnostic Level V, expert opinion. See Instructions for Authors for a complete description of levels of evidence.

Department of Orthopaedic Surgery, Hospital for Special Surgery, Foot and Ankle Service, New York, NY

C.A.D. is a paid consultant for Wright Medical Technology, Integra LifeSciences, Stryker, and RTI Surgical. The remaining authors declare no conflict of interest.

Address correspondence and reprint requests to Guilherme H. Saito, MD, Department of Orthopaedic Surgery, Hospital for Special Surgery, Foot and Ankle Service, 535 East 70th, New York, NY 10021. E-mail:

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