Ankle Arthritis

Contents

Foreword: Ankle Arthritis xi

Thomas Zgonis

Preface: Ankle Arthritis xiii

Jesse B. Burks

Supramalleolar Osteotomy for Realignment of the Ankle Joint 465

Noman A. Siddiqui, John E. Herzenberg, and Bradley M. Lamm

Ankle replacement systems have not been as reliable as hip replacementsin providing long-term relief of pain, increased motion, and return to fullactivity. Supramalleolar Osteotomy is an extraarticular procedure that re-aligns the mechanical axis, thereby restoring ankle function. The literaturediscussing knee arthritis has shown that realignment osteotomies of thetibia improve function and prolong total knee replacement surgery. Thesuccess of the procedure is predicated on understanding the patient’sclinical and radiographic presentation and proper preoperative assess-ment and planning.

Osteochondral Talar Lesions and Defects 483

Jason L. Seiter and Kenneth P. Seiter Jr

Talar dome lesions (TDL) have increasingly been the focus of interest ofmany foot and ankle surgeons over the past decade. The most importanttreatment aspect of TDL is diagnosis, so that appropriate treatment pro-tocols can be enacted in a timely and stepwise manner. Minor or mildTDL may be treated conservatively, while severe acute or chronic TDLcan be addressed with various surgical interventions. By being aware ofall practical treatment options and their indications, success rates, bene-fits, risks, and alternative options, specialists will be able to make an in-formed decision on appropriate care selection after perusing this article.

Ankle Arthrodiastasis and Interpositional Ankle Exostectomy 501

Bryan A. Sagray, Bradley A. Levitt, and Thomas Zgonis

Arthrosis of the ankle joint, typically posttraumatic in nature, can affectyounger andolder populations alike.Amultitudeofprocedures exist for treat-ment, such as arthrodesis, total joint replacement, arthrodiastasis, and artic-ular repair. Current literature has demonstrated success in articular surfacerepair and arthrodiastasis as separate procedures. This article reviews thetechnique of ankle arthrodiastasis and interpositional ankle exostectomy,consisting of background, mechanism of action, indications, patient selec-tion criteria, complications, and advantages in the current literature.

Ankle Arthrodesis: A Literature Review 509

Patrick A. DeHeer, Shirley M. Catoire, Jessica Taulman, and Brandon Borer

Ankle joint arthrodesis should be considered the gold standard procedurefor end-stage ankle arthritis in the appropriate patient. Incisional approach

Contentsviii

and fixation technique should be based on the patient and specific needs.Arthrodesis can be achieved with adequate resection of cartilage, goodcompression across the fusion site, stable fixation, proper postoperativeprotocol, and patient compliance. It is important to remember that position-ing of the ankle joint is a keystone in ankle arthrodesis. There are complica-tions that can arise from the ankle fusion, including the need for furthersurgical intervention owing to arthritis in the subtalar and midtarsal joints.

Tibiotalocalcaneal Arthrodesis 529

Jesse B. Burks

Combined arthrodesis of the ankle and subtalar joint is a challenging butpotentially rewarding procedure for certain patients. The author discussesmultiple aspects of the procedure from patient counseling to postoperativecomplications.

Total Ankle Replacement: A Historical Perspective 547

Benjamin D. Overley Jr

In the early 1970s, total ankle replacement was criticized because ofpoor outcomes with initial implant designs. Modifications were madethat lead to the development of several generations of implants. Theearly shortcomings gave researchers and surgeons the impetus to im-prove implant designs and surgical technique. Total ankle replacementhas become more widely accepted in recent years because of im-proved design and survivorship rates for the implants, as well asimproved patient satisfaction scores. Indications for total ankle replace-ment have broadened. To continue these successes, it is important forsurgeons to select appropriate patients for this procedure.

Revision of Failed Ankle Implants 571

Lawrence A. DiDomenico and Davina Cross

Total ankle joint replacement (TAR) has been offered as an alternative toankle joint arthrodesis since the 1970s. TAR offers the benefit of persever-ation of joint motion, with potential decreased occurrence of adjacent jointdegeneration, and a more expedient path to weight bearing. Since theirintroduction, TAR devices have undergone a variety of modifications,specifically in regards to the number and type of components used.

Current Concepts and Techniques in Foot and Ankle Surgery

Pinch Graft Harvesting Technique for Surgical Closure of the Diabetic Foot 585

Crystal L. Ramanujam and Thomas Zgonis

Skin grafting provides an efficient way for diabetic wound closure whenstandard conservative therapy has failed and primary surgical closure isnot an option. Pinch grafting provides an alternate method that canprovide durable closure for soft tissue loss in the diabetic foot. Anoverview of this technique and its indications for diabetic foot woundsis presented.

Contents ix

An Overview of Bone Grafting Techniques for the Diabetic Charcot Footand Ankle 589

Crystal L. Ramanujam, Zacharia Facaros, and Thomas Zgonis

Surgical options for diabetic Charcot neuroarthropathy of the foot and an-kle must take into consideration the challenging environment for bonehealing that accompanies these complex pathologic conditions. Bonegrafting has established an important role in reconstructive surgery to pro-mote bone formation, replacement, and repair. This article provides anoverview of available bone grafting methods in conjunction with a reviewof the literature on these techniques as they pertain to diabetic Charcotfoot and ankle reconstruction.

Index 597