Balancing and Stabilizing the Ankle

Balancing and stabilizing the ankle is the most challenging part of total ankle arthroplasty, and it is crucial for successful total ankle arthroplasty in the long term. The meticulous analysis is paramount for planning the replacement surgery and anticipating additional procedures to balance the ankle. Proper surgical technique is imperative to achieve an optimal outcome. Ultimately, deformities must be addressed at their origin by correcting osteotomies or arthrodeses below the ankle, especially for peritalar instability or degenerative disease as the origin. Furthermore, ligament reconstruction and tendon transfers may be considered in the case of persistent instability. Heel cord lengthening is seldom necessary when an extended posterior soft-tissue release is performed. Though not proven yet, using a fixed-bearing ankle may be more forgiving in balancing and stabilizing the replaced ankle than a mobile-bearing ankle, but with a higher risk of generating rotational torque or translational forces as the geometry of the prosthesis attempts to seek congruency.