Anterolateral approach for total ankle arthroplasty, preliminary results of a less-invasive surgical pathway: an...

Total Ankle Arthroplasty (TAA) has evolved into a reliable treatment option for end-stage ankle osteoarthritis; however, wound healing complications remain a significant concern, particularly with traditional anterior approaches. These complications are largely related to the vulnerability of the anterior soft-tissue envelope and may negatively affect early outcomes. The purpose of the present study was to evaluate the safety and early clinical outcomes of a curvilinear anterolateral approach for TAA, with particular focus on wound healing and soft-tissue complications. A retrospective observational study was conducted on 48 consecutive patients undergoing TAA between January 2023 and December 2025. A total of 49 ankle arthroplasties were performed using a curvilinear anterolateral approach. Patient demographics, comorbidities, and perioperative variables were recorded. Primary outcomes included wound-related complications and time to complete healing. Secondary outcomes included functional improvement assessed using the Foot and Ankle Outcome Score (FAOS). Three patients (6.1%) developed wound-related complications. Two patients (4.1%) experienced superficial wound dehiscence, which resolved with conservative treatment. One patient (2.0%) developed a deeper wound complication involving the soft tissues without prosthetic involvement; this case occurred in a high-risk patient with multiple comorbidities and was successfully managed with advanced wound care. No cases of deep prosthetic infection were observed. All remaining cases (93.9%) achieved uneventful wound healing within 12 to 21 days. Functional outcomes showed a significant improvement, with mean FAOS increasing from 40±5 preoperatively to 75±5 at final follow-up. The curvilinear anterolateral approach for TAA demonstrated a low rate of wound-related complications and consistent early functional improvement. By preserving the tibialis anterior tendon sheath and optimizing incision placement, this technique may reduce both vascular and mechanical risk factors associated with wound healing disorders. It represents a safe and reproducible alternative to traditional anterior and transfibular approaches, particularly in patients at increased risk for soft-tissue complications.