A 50-year-old woman with psoriatic arthritis has severe pain and instability of the left ankle with radiographic evidence of joint destruction and periarticular erosions. She has failed 18 months of biologic therapy and has preserved ankle motion. The most appropriate surgical intervention is:
- A Below-knee amputation
- B Triple arthrodesis (subtalar, talonavicular, calcaneocuboid)
- C Ankle arthrodesis (tibiotalar fusion) ✓
- D Total ankle replacement
Correct answer: C. Ankle arthrodesis (tibiotalar fusion)
Explanation
Ankle arthrodesis (tibiotalar fusion) is the gold standard surgical treatment for end-stage ankle arthritis in psoriatic arthritis when conservative measures fail. Total ankle replacement is contraindicated in inflammatory arthropathy due to higher failure rates from ongoing synovitis and bone loss. Triple arthrodesis is for hindfoot deformity not isolated tibiotalar disease. Amputation is never first-line for psoriatic arthritis.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.