Preoperative planning of total ankle prosthesis – What are we aiming at?

Abstract

IntroductionAnkle osteoarthritis poses significant challenges, affecting patients’ quality of life and often necessitating surgical intervention. Total ankle replacement (TAR) has emerged as an effective treatment, in patients with post-traumatic arthritis. Precise preoperative planning is crucial for achieving optimal outcomes in TAR procedures. This article explores the use of advanced imaging techniques, virtual modeling, and surgical strategies in preoperative planning for TAR. MethodsThe preoperative planning process involves thorough patient assessment, including clinical examination and imaging studies such as Weight Bearing CT scans (WBCT) and MRI. Classification systems like the Canadian Orthopedic Foot & Ankle Society (COFAS) classification help guide treatment decisions and staging of procedures. Virtual foot/ankle models derived from WBCT scans enable accurate assessment of deformities and facilitate precise implant positioning. DiscussionOptimal TAR outcomes rely on restoring normal ankle anatomy and function while addressing associated deformities and pathology. Precise alignment, joint congruency, and rotational positioning of implant components are Important considerations. Virtual planning allows for simulation of implant placement and axis correction, aiding surgical decision-making and predicting outcomes. However, it has limitations in predicting soft tissue effects and final implant size. ConclusionPreoperative planning plays a important role in TAR procedures, understanding optimal implant placement. Advanced imaging modalities, classification systems, and virtual modeling techniques enhance surgical precision. Continued refinement of preoperative planning strategies is essential for further advancing TAR outcomes and patient satisfaction.10.1016/j.fuspru.2024.07.001