Total Ankle Replacement Through a Lateral Transfibular Approach in Patients with Ipsilateral Knee Arthrodesis: Report of Two Cases

TL;DR

This paper reports successful total ankle replacement in two patients with a fused knee, showing pain relief and improved mobility.

Contribution

The study presents the first reported cases of TAR using a lateral transfibular approach in patients with ipsilateral knee arthrodesis.

Findings

Both patients experienced significant pain reduction and improved ankle range of motion.

Stable, functional gait was achieved without major complications or reoperations.

Imaging showed well-aligned, stable implants with no loosening or subsidence.

Abstract

Background: Knee arthrodesis markedly alters lower limb biomechanics and creates a challenging scenario when associated with end-stage ankle osteoarthritis. No prior reports have specifically described treatment with total ankle replacement (TAR) in the presence of an ipsilateral fused knee. This study evaluated the feasibility and mid-term outcomes of TAR in this rare condition. Methods: Two patients with post-traumatic end-stage ankle osteoarthritis and long-standing knee arthrodesis underwent TAR using a lateral transfibular approach with a Zimmer Trabecular Metal™ implant. Surgical planning aimed to restore coronal and sagittal alignment. Postoperative management and rehabilitation were specifically adapted to the absence of knee motion, with emphasis on gait re-education. Clinical and radiographic follow-up was performed up to 36 months. Results: At final follow-up, both patients showed substantial pain reduction, improved ankle range of motion, and recovery of a stable, functional gait compatible with knee fusion. Imaging demonstrated well-aligned, stable components without loosening or subsidence. No major complications or reoperations occurred. Conclusions: Lateral transfibular TAR appears feasible and effective for end-stage ankle osteoarthritis in patients with ipsilateral knee arthrodesis, preserving ankle motion and supporting functional ambulation in this complex setting.

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