2025 AOFAS Annual Meeting-Symposium 6A: Total Ankle Arthroplasty 1: Associated Deformities

Video Transcription

Video Summary

This symposium featured expert discussions on managing ankle deformities—specifically varus and valgus—during total ankle replacement surgeries. Dr. David Petterwitz detailed his approach to varus deformities, emphasizing the importance of thorough deformity assessment (location, congruency, plane) and staged corrections including osteotomies, soft tissue releases (notably deltoid release), and possible hindfoot fusions. Complex varus cases often require multiple surgical steps to achieve joint congruency and implant longevity.<br /><br />Dr. Timothy Daniels addressed valgus ankle deformities, highlighting their varied etiologies, including post-traumatic, progressive collapsing flatfoot, and ball-and-socket joints. He stressed the use of medial translation osteotomies, ligament reconstructions, and sometimes staged procedures for deformity correction. Fibular dysplasia and syndesmosis widening present unique challenges requiring osteotomies or ligamentous repair to restore ankle stability.<br /><br />Scott Ellis underscored the crucial interplay between foot and ankle alignment for successful outcomes. He advocated comprehensive imaging (weight-bearing X-rays, CT, MRI) and patient-specific instrumentation to guide correction. For both varus and valgus deformities, balancing bone cuts with careful soft tissue management, including ligament reconstructions and tendon transfers, is essential. Staging procedures when necessary improves outcomes.<br /><br />The panelists also discussed technical nuances such as fibular lengthening osteotomies, tourniquet management during lengthy surgeries, and use of PSI (patient-specific instrumentation), noting it's a helpful tool but essential to master traditional techniques. Overall, the emphasis was on individualized, staged, and comprehensive deformity correction to optimize total ankle replacement success.

Keywords

ankle deformities

varus deformity

valgus deformity

total ankle replacement

osteotomies

soft tissue release

hindfoot fusion

patient-specific instrumentation

ligament reconstruction