Case 3. Total Ankle Replacement: A Focus on Clinical Decision Making

Description

In this presentation, Paul Halliwell discusses the considerations surrounding total ankle replacement (TAR) for a 65-year-old female patient in good health, who prefers an ankle replacement but is open to options. He presents her clinical examination findings, highlighting aspects such as her flat foot and correctable ankle valgus and forefoot varus deformities. Halliwell weighs the benefits of TAR against arthrodesis (fusion), raising important questions about early function, potential wear of complex devices used in ankle replacements, and the risk of exacerbating subtalar joint pain.



The dilemma is whether the quality of life and early function with TAR justifies its risks compared to fusion, especially given that arthritis can develop in adjacent joints post-fusion. Halliwell emphasizes that while TAR may provide better outcomes in terms of motion in polyarthritic patients, early failure is associated with pre-existing deformities. Thus, skillful identification and correction of deformities are crucial for successful TAR outcomes.



He also discusses trends in literature supporting the effectiveness of TAR despite deformities when they are properly managed. The talk culminates in a call for greater collaboration among surgeons, advocating for patient access to a range of treatment options for ankle arthritis, ultimately aiming to enhance patient care through comprehensive networks.

Specialties