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Updated: Jun 20, 2026
Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
[Computer-assisted surgery-(CAS-) guided correction arthrodesis of the ankle joint]
1II. Chirurgische Klinik, Unfallchirurgie, Orthopädie und Fusschirurgie, Klinikum Coburg, Coburg, Germany. martinus.richter@klinikum-coburg.de
Objective:
Restoration of a stable and plantigrade foot in deformities at the ankle and concomitant degenerative changes at the ankle joint.
Indications:
Deformities at the ankle and concomitant degenerative changes at the ankle joint.
Contraindications:
Active local infection or relevant vascular insufficiency.
Surgical Technique:
Supine position and anterior approach to the ankle joint. Placement of dynamic reference bases (DRBs) in tibia and talus. Two-dimensional (2-D) image acquisition for navigation. Definition of axes of tibia and talus, and of the extent of correction. Exposition of the ankle joint and removal of remaining cartilage. Computer-assisted surgery-(CAS-) guided correction and transfixation of the corrected position with two 2.5-mm Kirschner wires. Transplantation of autologous cancellous and cortical bone, if necessary. 3-D image acquisition for analysis of the accuracy of the correction and planning of the drillings for the four screws (two parallel from anterolateral, one from posteromedial from the tibia, and one from lateral from the fibula). CAS-guided drilling and insertion of the screws. 3-D image acquisition for analysis of the accuracy of the correction and implant position. Layerwise closure.
Postoperative Management:
Partial weight bearing with 15 kg in an orthosis for 6 weeks, followed by full weight bearing in a stable standard shoe.
Results:
From September 1, 2006 to August 31, 2008, 24 correction ankle arthrodeses were performed. The accuracy was assessed by intraoperative 3-D imaging. All achieved angles/ translations were within a maximum deviation of 2 degrees /2 mm when compared to the planned correction. Complications that were associated with CAS were not observed. In all 20 patients that completed follow-up so far, a timely fusion was registered.
