Hindfoot balancing in total ankle replacement: the role of supramalleolar osteotomies

Associated Corrective Procedures of Extra-Articular Asymptomatic Foot Malalignments in Total Ankle Replacement: Are They Really Mandatory?

“…However, the risk–benefit ratio connected to additional surgical procedures must be considered, according to a kind of “balance effect” that can move its needle towards the necessity of surgery or not, on the basis of a careful pre-operative and intra-operative assessment. The reasons against the execution of associated surgical procedures in asymptomatic foot malalignments include increased intraoperative risk due to the complexity of the surgery, increased soft tissue stress (with potential infectious or vascular complications) and operating time, and delayed bone consolidation or nonunion that could lead to revision bone surgery [ 6 ]. On the other hand, the elements in favor of additional surgery during TAR are represented by a better protection of the prosthetic components in the long term, thanks to a better distribution of load vectors and forces on the implant.…”

“…In summation, the stakes are high. Revision TAR involves a more complex and risky surgery, since the bone stock is limited [ 6 ] and the lower limb symmetry is compromised, requiring experienced surgeons to manage it. The aim of this short editorial is to raise points of view, discussions, and questions, with the need for further in-depth and long-term studies regarding the use of associated procedures in case of asymptomatic foot deformities, instability, or osteoarthritis to reduce the incidence of revision surgery in the long-term follow-up.…”

Patient-specific instrumentation in total ankle arthroplasty

“…During the templating, deformity correction must be evaluated and addressed. Realignment procedures can be performed before TAA surgery or simultaneously to the prosthesis implantation, acting on bone or soft tissue structures depending on patho-anatomy[ 18 , 19 ].…”