A 57-year-old patient presented with longstanding ankle pain refractory to conservative treatment. Prior nanoscopic debridement with platelet rich plasma injection provided only six months of relief. Imaging demonstrated significant joint space narrowing, subchondral sclerosis, exostoses at the talar neck, subtalar joint, talar gutters, as well as a cavovarus hindfoot alignment consistent with end-stage ankle arthritis.
The team proceeded with total ankle arthroplasty with patient specific instrumentation (PSI). After placement of the PSI, intraoperative varus tilting revealed the need for a concomitant lateral ankle ligament reconstruction. The forefoot-driven cavovarus hindfoot deformity was corrected with a first metatarsal dorsiflexion osteotomy.
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