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Updated: Jun 8, 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 subtalar joint]
1II Chirurgische Klinik, Unfallchirurgie, Orthopädie und Fußchirurgie, Klinikum Coburg, Coburg. martinus.richter@klinikum-coburg.de
Objective:
Restoration of a stable and plantigrade foot in deformities at the hindfoot and concomitant degenerative changes at the subtalar joint.
Indications:
Deformities at the hindfoot and concomitant degenerative changes at the subtalar joint.
Contraindications:
Active local infection or relevant vascular insufficiency.
Surgical Technique:
Prone position and posterolateral approach to the subtalar joint. Placement of dynamic reference bases in talus and calcaneus through stab incisions. Two-dimensional image acquisition for navigation. Definition of the axes of talus and calcaneus, and of the extent of correction. Exposure of the subtalar 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. Three-dimensional (3-D) image acquisition for analysis of the accuracy of the correction and planning of the drillings for the screws. CAS-guided drilling and insertion of the screws. 3-D image acquisition for analysis of the accuracy of the correction implant position. Wound closure in layers.
Postoperative Management:
15 kg partial weight bearing in an orthosis (e.g. Vacuped TM, OPED Inc., Valley, Germany) for 6 weeks, followed by full weight bearing in a stable standard shoe.
Results:
From September 1, 2006 to August 31, 2008, 26 correction arthrodeses were performed. The accuracy was assessed by intraoperative 3-D imaging. All achieved angles/translations were within a maximum deviation of 2°/2 mm when compared to the planned correction. Complications that were associated with CAS were not observed. In all 25 cases that completed 2-year follow-up, timely fusion was registered.
