Algorithms for the Treatment of Complex Deformities

Careful radiographic assessment of the talar position in all three planes is mandatory to successfully replace an end-stage osteoarthritic ankle joint associated with a concomitant major coronal and sagittal plane deformity. As correcting resection cuts for the prosthesis may not be able to restore the proper position of the talus within the ankle mortise and provide overall stability of the ankle, additional osteotomies above or below the ankle or selective fusions may be necessary to obtain a well-balanced ankle and hindfoot joint complex. The key to success is to use all treatment modalities necessary to restore the appropriate alignment of the hindfoot complex. Using established algorithms may improve outcomes, particularly for complex deformities.