Total Ankle Replacement Through a Lateral Approach

Since the first clinical series of total ankle replacements in 1973, implants design has evolved tremendously. Early catastrophic failures associated with first-generation total ankle replacement are now less common with modern prostheses. However, registry data suggest that the 10-year survivorship is still lower than total knee and hip arthroplasty. The anterior surgical approach used in the vast majority of implants lies between 2 angiosomes and can lead to complications including wound breakdown and damage to the peroneal nerves and anterior tibial artery. Furthermore, current anterior approach implants do not allow bony resections to parallel the sagitally curved talar and tibial surfaces; cuts are limited to flat/chamfered cuts which inherently take more bone than curved, matched, bony resections. In 2012, the FDA approved the Zimmer Trabecular Metal Total Ankle Replacement, which is a placed through the lateral approach. This approach theoretically minimizes surgical intrusion on a previously traumatized anterior soft-tissue envelope and allows direct visualization of the curved talus and tibial surfaces. In addition, such an approach allows bone-sparing, curved resections that maximize bony contact and theoretically minimize component subsidence. Furthermore, this implant is based on using a rigid alignment stand to which the lower extremity and milling guides are fixed, allowing for both the correction of deformity and the accurate resection of bone. The aim of this paper is to present the design rationale and useful technical tips for surgeons implanting this prosthesis. Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.