[Total ankle arthroplasty with simultaneous subtalar fusion]

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Reconstruction
• Joint Arthroplasty

Background:

• Symptomatic arthritis of the ankle and subtalar joint often presents with hindfoot malalignment.
• Conservative treatments may fail, necessitating surgical intervention for pain relief and functional restoration.

Purpose of the Study:

• To evaluate the outcomes of simultaneous total ankle arthroplasty and isolated subtalar fusion.
• To assess the procedure's efficacy in achieving pain-free weight-bearing and improving ankle function.

Main Methods:

• A lateral approach was used for subtalar joint preparation and fixation with compression screws (5-10° valgus).
• An anterior approach was employed for total ankle arthroplasty implantation.
• Postoperative management included cast immobilization, followed by a walker boot with progressive weight-bearing and physical therapy.

Main Results:

• A cohort of 41 patients underwent the combined procedure between 1998 and 2016.
• The study reported a 92.6% consolidation rate for the subtalar fusion.
• Mean AOFAS Ankle-Hindfoot Score improved from 51.6 to 79.7 one year post-surgery, with a mean total range of motion of 32.3°.

Conclusions:

• Simultaneous total ankle replacement and isolated subtalar fusion is an effective treatment for complex ankle and hindfoot arthritis.
• The procedure leads to significant improvements in patient-reported outcomes and functional mobility.
• Achieving an orthograde hindfoot position and preserving tibiotalar motion are key objectives met by this surgical approach.