Live Webinar: Total Ankle - Getting It Right the First Time-Foot & Ankle Focus: Total Ankle: Getting It Right the First Time

Video Transcription

Video Summary

This AOFAS Foot & Ankle Focus webinar, “Total Ankle: Getting it Right the First Time,” brings together experts to review how to optimize outcomes in total ankle arthroplasty (TAA) through patient selection, surgical execution, deformity management, and complication response.<br /><br />Dr. Andrew Hanselman emphasizes that patient selection and preoperative optimization are often more important than technical skill. Key screening domains include expectations (pain relief over “normal” motion; avoiding high-impact activity), age counseling (younger patients may do well but face higher lifetime revision risk), bone quality/stock (CT, concern for cysts/AVN), vascular status (pulse exam, ABI/toe pressures, low threshold for vascular consult), soft tissue risk (prior incisions, thin coverage, autoimmune vasculitis), nicotine exposure (including pouches; recommends ≥6 weeks cessation and cotinine testing), nutrition (vitamin D goal >30—preferably ~50; consider protein status), diabetes control (often acceptable if controlled—he targets HbA1c ~7.5), neuropathy thresholds, autoimmune medication coordination, and careful workup of prior infection risk.<br /><br />Dr. Elizabeth Cody reviews technical priorities: implants should be parallel to the ground and aligned to the mechanical axis; avoid tibial component varus and internal rotation; avoid talar oversizing; and aggressively debride gutters to prevent impingement (a leading cause of reoperation). She cautions PSI does not guarantee alignment, stresses deliberate fluoroscopic checks, joint-line preservation, and addressing stability and foot alignment (often with first-ray procedures). Achilles/gastroc lengthening is used selectively based on postoperative dorsiflexion.<br /><br />Dr. Konstantin Dimetricopoulos focuses on concomitant deformity correction as essential for durability, outlining varus/valgus algorithms, when to stage procedures, and the principle of achieving a stable, plantargrade, balanced foot under the ankle.<br /><br />Dr. Jeremy McCormick discusses early failures—malalignment, aseptic loosening, and infection—highlighting prevention, early recognition, appropriate workup, and decisive management (including liner exchange vs staged revision and early flap involvement when needed).

Asset Subtitle

Moderator: Kelly K. Hynes, MD

Faculty: Andrew E. Hanselman, MD; Elizabeth A. Cody, MD; Constantine A. Demetracopoulos, MD; Jeremy J. McCormick, MD

This webinar will focus on a 360 approach to primary total ankle replacements, from indications and planning, to surgical technique, to learning from complications. Our expert panel of surgeons has a wealth of total ankle replacement experience and passion.

At the conclusion of this webinar, you will be able to:

Have the foundation for indications and planning for primary total ankle replacement
Develop strategies for implant positioning and balancing in total ankle replacements
Understand the aspects of total ankle replacement that risk early complications and how to identify those issues intraoperatively

Keywords

total ankle arthroplasty

AOFAS Foot & Ankle Focus webinar

patient selection

preoperative optimization

implant alignment

mechanical axis

tibial component varus

talar component sizing

gutter debridement

varus valgus deformity correction

plantigrade balanced foot

early failure management

infection and aseptic loosening