Implantation of a Total Ankle Replacement Prosthesis using a Lateral Surgical Approach is Precise and Effective

Introduction: The objectives of this study were to determine if a canine total ankle replacement (cTAR) prosthesis could be safely placed using a lateral surgical approach by comparing implant placement, construct stability, and tarsocrural stability of implants placed in cadaveric limbs using a medial or lateral approach.

Materials and Methods: Ten pelvic limbs from five skeletally mature large-breed dogs were used. Paired limbs received a cTAR randomly placed using a medial or a lateral approach. Mediolateral and craniocaudal digital radiographs were collected in all limbs using standard projections. Radiographic stress views were acquired with the tarsus held at 90 degrees and held in extension before and after implant placement.

Results: The surgical approach did not affect the pes orientation in the transverse plane without stress or with lateral or medial stress (p = 0.175, 0.367, and 0.486, respectively), varus or valgus with the tarsus extended (p = 0.675 and 0.155), maximal tarsal flexion angle (p = 0.152), and polar gap measurements along the tibial and talar components of the implant (p = 0.913 and 0.825, respectively). The medial approach significantly decreased tarsal flexion by 8 degrees (p = 0.036) and external rotation of the tibia relative to the pes without stress by 2 degrees (p = 0.027). The lateral approach did not change any parameter.

Discussion/Conclusion: No statistically significant difference in implant placement, construct stability, or tarsocrural stability of the implants was present among the medial and lateral approaches. Our findings demonstrate that the cTAR prosthesis can be safely implanted using a lateral approach. The medial approach may lead to a reduction in tarsal flexion.

Acknowledgment

This study was funded by Access Bone and Joint Center, Culver City, California.

 

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Publication History

Article published online:
15 July 2025