Total ankle arthroplasty in endstage varus ankle osteoarthritis

In end-stage ankle osteoarthritis (OA) more than half of all patients show a varus malalignment (tibiotalar surface angle <90°). Total ankle arthroplasty (TAA) preserves tibiotalar joint motion with a low incidence of secondary subtalar joint fusion, offering a better health-related quality of life than ankle arthrodesis. The most important factors in the preoperative assessment are highlighted. Intraoperative key points are illustrated and the current literature is discussed regarding the outcome of TAA in varus ankle OA. Of paramount importance for a satisfactory outcome is to reestablish neutral alignment, ligamentous stability and a plantigrade foot. This frequently necessitates soft-tissue and bony concomitant procedures.