Total Ankle Replacement

Description

In this comprehensive surgical video presentation, Scott Ellis, an orthopedic surgeon specializing in foot and ankle procedures at the Hospital for Special Surgery, walks viewers through the intricacies of a total ankle replacement surgery. The patient, suffering from end-stage ankle arthritis complicated by a history of clubfoot and previous Achilles lengthening, presents unique challenges due to the anatomy of her small foot and flat talus.



Scott carefully discusses the preparation and crucial steps of the procedure, highlighting the importance of patient-specific instrumentation and the use of a stemmed implant for optimal fit.



The procedure begins with an anterior exposure, where Scott meticulously identifies anatomical structures, like the superficial peroneal nerve, while making the necessary sacrifices to ensure proper access.



As he progresses through the surgery, Scott emphasizes the importance of careful dissection to protect neurovascular bundles and the underlying structures. He demonstrates techniques for exposing the ankle joint while remaining aware of previous trauma and scarring that could complicate exposure.



After achieving necessary exposure, Scott explains how to properly align cutting guides and ensure correct implant placement. He highlights critical steps like reaming to prepare the joint for implant insertion, checking alignment with x-rays, and using wires for stability during the process.



Throughout the procedure, Scott discusses the rationale for certain surgical choices, including the downsizing of the talar implant to avoid overhang and improve joint function. He provides insights into ensuring proper debridement of gutters to prevent impingement post-surgery.



Following the implant placement, Scott meticulously closes the surgical site using layered approaches, noting the importance of ensuring that all structures are properly secured without compromising the surrounding tissues.



Concluding, Scott reflects on the entire process, summarizing the challenges faced due to the patient’s unique anatomy and previous surgeries, while highlighting the successes achieved with careful planning and execution. The video offers an educational insight into advanced orthopedic surgical techniques, aimed at both medical professionals and students.

Specialties