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Updated: May 22, 2026

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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The mangled foot and ankle: results from a 2-year prospective study.

J Kent Ellington1, Michael J Bosse, Renan C Castillo

  • 1OrthoCarolina, Foot and Ankle Institute, Charlotte, NC, USA.

Journal of Orthopaedic Trauma
|May 8, 2012
PubMed
Summary

Limb salvage surgery for severe foot and ankle injuries requiring free flaps resulted in worse outcomes compared to early below-knee amputation (BKA). Patients undergoing salvage had higher disability scores at two years.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Reconstructive Surgery

Background:

  • Severe foot and ankle injuries present complex challenges in treatment and outcome.
  • Limb salvage versus amputation is a critical decision with long-term implications for patient function.
  • Free tissue flaps and ankle arthrodesis are advanced techniques used in complex limb salvage.

Purpose of the Study:

  • To compare the 2-year outcomes of limb salvage surgery using free tissue flaps with early below-knee amputation (BKA) for severe foot and ankle injuries.
  • To evaluate functional status, pain, rehospitalizations, and return to work in patients undergoing different treatment pathways.

Main Methods:

  • Prospective longitudinal study conducted at eight Level 1 trauma centers.
  • 174 patients with open, severely injured hindfoot or ankle injuries were included (116 salvage, 58 BKA).

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  • Outcomes measured using the Sickness Impact Profile (SIP), walking speed, rehospitalizations, time to weight-bearing, pain scale, and return to work.

    • Main Results:

    • Patients undergoing limb salvage requiring free flaps or ankle arthrodesis had significantly worse 2-year outcomes, with higher overall and psychosocial SIP scores.
    • Physical SIP scores were also higher in the salvage group, approaching statistical significance.
    • After adjusting for free flap/arthrodesis, salvage showed clinically, but not statistically, better SIP scores than BKA.

    Conclusions:

    • Severe foot and ankle injuries treated with limb salvage requiring free tissue transfer or ankle fusion result in significantly worse Sickness Impact Profile outcomes compared to below-knee amputation (BKA).
    • The choice of treatment pathway significantly impacts long-term patient disability and functional recovery.