A 34-year-old manual labourer has severe post-traumatic arthritis of the ankle following a pilon fracture, with varus malalignment and subchondral bone loss. Which procedure offers the most durable outcome in this patient?
- A Total ankle arthroplasty with a three-component mobile-bearing prosthesis
- B Total ankle arthroplasty with a fixed-bearing two-component prosthesis
- C Ankle arthrodesis, preferably arthroscopic if the deformity is correctable ✓
- D Distraction arthroplasty with an external fixator
Correct answer: C. Ankle arthrodesis, preferably arthroscopic if the deformity is correctable
Explanation
Modern total ankle replacements give their best results in older, low-demand patients with good bone stock, preserved coronal alignment and adequate soft tissues. Young, heavy-demand patients with post-traumatic deformity and bone loss have high rates of loosening, subsidence and failure with arthroplasty, so arthrodesis remains the durable standard in this group. Arthroscopy is preferred where the deformity is correctable because fusion and complication rates compare favourably with open techniques.
Reference: Campbell's Operative Orthopaedics, 14th ed.
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