foot ankle

Total Ankle Arthroplasty

advanced

6 min

28 marks

6 questions

Clinical Scenario

A 62-year-old retired female teacher presents with severe right ankle pain over 5 years, progressively limiting her walking distance to 200 meters. She has post-traumatic ankle arthritis following a pilon fracture 12 years ago treated with ORIF. She requires daily analgesia and a walking stick. Clinical examination reveals a stiff, painful ankle with 15° total arc of motion (10° dorsiflexion, 5° plantarflexion), neutral hindfoot alignment, and no significant ligament laxity. The subtalar joint is well-preserved. She is a non-smoker with well-controlled Type 2 diabetes (HbA1c 6.5%).

Weight-bearing radiographs and CT are provided.

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Clinical image for Total Ankle Arthroplasty

Source: Total Ankle Arthroplasty Radiograph • PMC5367591 • CC-BY

Questions

Question 1 (4 marks)

What are the causes of ankle arthritis? Describe the pathophysiology and natural history.

Question 2 (5 marks)

Compare and contrast total ankle arthroplasty (TAA) and ankle arthrodesis. What are the indications and contraindications for each?

Question 3 (6 marks)

Describe your preoperative assessment for this patient. What factors influence your surgical decision?

Question 4 (5 marks)

Describe the key principles and surgical technique for total ankle arthroplasty.

Question 5 (4 marks)

What are the common complications of TAA? How would you manage early failure?

Question 6 (4 marks)

What is the role of concurrent procedures with TAA? Discuss management of adjacent joint arthritis and deformity correction.

Exam Tips

→Minimal tibial resection: 2-3mm below subchondral bone
→Deformity limit: <10-15°
→Talar cyst acceptable: <30% involvement
→HbA1c target: <7.5%