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Joint-Sparing Treatment of Ankle Arthritis With Coronal Plane Deformity
Because the etiology of ankle arthritis is posttraumatic in most patients, deformity is a common finding. The deformity can be in the coronal plane (varus or valgus) or in the sagittal plane (procurvatum or recurvatum). In some patients, the deformity also includes malrotation. Because of its posttraumatic nature, ankle arthritis frequently becomes symptomatic much earlier than does idiopathic arthritis of the hip or the knee. This fact underscores the importance of long-lasting treatment options for this patient group, particularly with regard to joint-preserving options. Photometric assessment, gait analysis, and biomechanical studies (in cadaver and animal models) have shown substantial alteration of the biomechanics in ankles with deformities. Furthermore, in most patients, arthritis of the ankle joint is mechanically induced and not of inflammatory nature. On the basis of these findings, correction of supramalleolar alignment in patients with varus or valgus arthritis of the ankle joint (asymmetric arthritis) has gained increasing popularity for the management of early and midstage arthritis to postpone fusion or surgical replacement. This chapter reviews surgical strategies for balancing the ankle in the management of varus and valgus deformity in patients with posttraumatic ankle arthritis.