Avoiding Wound Complications in Total Ankle Arthroplasty: Surgical Technique and Tips.

INTRODUCTION: This technique guide is intended to help surgeons to avoid pitfalls and optimize the surgical technique for implantation of a total ankle prosthesis. STEP 1 PREOPERATIVE PLANNING: Obtain radiographs and other relevant images and perform accurate templating. STEP 2 PATIENT POSITIONING: Position the patient with the foot and patella facing directly forward, and mark the anterior tibial crest. STEP 3 SURGICAL APPROACH: Incise the ankle, taking care to avoid injury to the superficial peroneal nerve and to protect the deep neurovascular bundle. STEP 4 BONE CUTS AND COMPONENT IMPLANTATION: Make the bone cuts in the distal part of the tibia and the talar dome, taking care to avoid excessive bone resection from the distal part of the tibia, fracture of the malleoli, or penetrating too deeply. STEP 5 SOFT-TISSUE BALANCING: Make adjustments as needed for optimal range of motion, alignment, and joint balancing; then remove the trial components and insert the final components. STEP 6 WOUND CLOSURE: Repair the extensor retinaculum and close the wound, taking measures that help avoid wound-related complications. RESULTS & PREOP/POSTOP IMAGES: Despite careful patient selection and surgical technique in our series of 106 consecutive total ankle arthroplasties performed with the Agility system, twenty-seven ankles (25%) had problems related to the anterior incision that required local wound care or oral antibiotics and then healed without subsequent consequences. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.