Total Ankle Arthroplasty with Anatomic Lateral Ankle Stabilization (ATLAS) using Synthetic Graft for Instability in Moderate and Severe Pre-Operative Varus Alignment

Abstract

Category: Ankle; Other Introduction/Purpose: More than 50% of patients undergoing Total Ankle Arthroplasty (TAA) have some degree of coronal deformity, which is the most common reason for additional procedures. The purpose of the present study was to assess the early clinical and radiographic outcomes for patients who underwent TAA and Anatomic Lateral Ankle Stabilization (ATLAS) using synthetic graft for instability in moderate and severe preoperative varus alignment. Methods: Seven ankles with moderate or severe varus alignment underwent TAA with a 3rd generation prosthesis (INBONE-2) and ATLAS using synthetic graft between September 2018 and February 2019 at a single institution, and were at least 1 year postoperative (mean 13.3 months, range 12-15). Medical records and charts were reviewed for any revisions, reoperations, or complications. Weight bearing radiographs were assessed using coronal and sagittal alignment parameters preoperatively, and during the latest follow-up. Results: Survivorship for INBONE-2 with ATLAS was 100%; recurrent instability was not observed. Symptomatic talonavicular joint arthritis was recorded for a single patient 12 months postoperatively; there were no revisions, or reoperations. Tibiotalar coronal alignment improved significantly from 17.7 +- 9.3 (range, 10.1-33.6) to 2.3 +- 1.2 (range, 0.9-4.4) degrees (p<0.006), and all ankles achieved neutral alignment in single stage. Regarding sagittal tibiotalar alignment, preoperatively 2 ankles (28.5%) were translated anteriorly and the rest were neutral (71.5%). Significant posterior translation was observed and during the latest follow- up, 4 ankles were neutral (57.1%) and 3 posterior (42.9%) (p<0.009). Conclusion: Satisfactory outcomes were observed at a minimum of 1-year follow-up for patients with moderate or severe varus alignment who underwent TAA with INBONE-2 and ATLAS. ATLAS using synthetic graft may afford advantages over previously described repair techniques. Comparative studies between the Brostrum-Gould and ATLAS are warranted in the TAA population.