By James K. DeOrio MD, Selene G. Parekh MD
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Additional info for Total ankle replacement : an operative manual
Sample text
Medial or lateral ligament instability must also be assessed and corrected to maintain stability of the ankle after surgery. Deformity below the ankle can be forefoot or hindfoot driven and may be associated with muscle imbalance. It may be the result of muscle spasticity, tendon or ligament dysfunction, or functional loss as a result of previous trauma. Chronic medial or lateral ligament instability may also lead to deformity. Hindfoot and forefoot alignment is assessed by careful physical examination preoperatively.
Weight-bearing radiographs should be reviewed for any coronal or sagittal plane malalignment to allow planning for correction. It is critical to evaluate the alignment of the hip and knee as well. Neutral alignment is essential to maximize the longevity of the prosthesis. If malalignment is present, full-length radiographs from the hip to the ankle may be required. Any signs of avascular necrosis (AVN) of the distal tibia or talar body should be noted (Fig. 2). Unresectable AVN is a contraindication to TAR as there is limited potential for ingrowth of the prosthesis and the components are at significant risk for subsidence with collapse of the underlying bone.
Tendon transfers may include flexor hallucis longus (FHL) for peroneal deficiency or extensor hallucis longus for tibialis anterior deficiency. # 151733 Cust: LWW Au: DeOrio Pg. No. 1. Standing AP and lateral views prior to TAA. If there is any concern with regard to midfoot arthritis, or hindfoot or forefoot deformity, then a standing AP and a lateral view of the foot should also be obtained. AP view (A) and lateral view (B) of a patient considered for TAA are shown. The subtalar joint had arthritis and this was confirmed by CT scan.
