Purpose: To review short-term results in 25 patients that underwent total ankle replacement with implantation of a second generation prosthesis.

Materials and methods: We reviewed 25 patients with ankle arthritis treated by total ankle replacement (TAR). Mean age of the patients was 58.2 years and mean follow-up 29.5 months. The cause of arthritis was posttraumatic in 17 cases. In all cases a HINTEGRA prosthesis was implanted. In 6 cases Achilles tendon lengthening was also performed. Review was carried out by anamnesis, clinical examination and radiological control. The ankle and hindfoot AOFAS scale was used to quantify clinical and functional results.

Results: Mean AOFAS score improved from 24.0 to 80.1 points. No significant differences were found between cases of traumatic and non-traumatic origin. Pain was the parameter with the best evolution. Mean ankle mobility went from 19° to 26°. Five cases required revision surgery: 2 ankle arthrodeses due to prosthetic loosening, 2 Achilles tendon lengthenings and one release of tibio-talar impingement. Prosthetic survival rate at 29.5 months’ follow-up was 92%. All patients, except for the 2 cases that required arthrodesis, were satisfied or very satisfied.

Conclusions: Total ankle replacement is an effective method for the treatment of ankle arthritis. Short term results are similar or better than those seen with arthrodesis.

Introduction and purpose: Numerous surgical procedures have been developed for the treatment of chronic ankle instability, which can be broken down into two: tenodesis of the peroneus brevis and ligament capsuloplasty. We assess the indications for these procedures, discuss their advantages and disadvantages based on a comparative review, and describe an algorithm in the treatment of this pathology.

Materials and methods: We reviewed 21 patients who underwent surgery from 1997 to 2001. In 10 of the patients the operation consisted of a Castaing II procedure with tenodesis of the peroneus brevis, and in 11 a Larsson procedure was performed as a ligament capsuloplasty. The ankle was evaluated using the AOFAS scale.

Results: The age difference between the two groups, which was 40 for those undergoing the Castaing II procedure and 28 for the Larsson technique. The mean AOFAS score was 80% (min. 70%, max. 95%) for the Castaing II procedure and 86% (min. 71%, max. 97%) for the Larsson technique.

Conclusions: The use of tenodesis with the peroneus brevis is indicated for severe ankle instability, failed anatomical repairs and in patients with connective tissue pathology. A capsuloplasty that attempts to reconstruct the lateral ligaments of the ankle as anatomically as possible is indicated for mild-to-moderate chronic instability in young patients.

Objective: The objective of this retrospective study is to evaluate our results with proximal closing-wedge osteotomy of first metatarsal for the treatment of hallux valgus with severe intermetatarsal (IM) angle and normal proximal articular set angle (PASA).

Material and methods: We reviewed 110 patients (141 feet) who had been treated by proximal closing-wedge osteotomy of first metatarsal between March-97 and February-04. 87% were women and the mean age was 47.8 years. A single cannulated screw was used for osteotomy fixation in 82% of patients. Additional procedures as phalangeal osteotomy or Keller resection were done when necessary.

Results: With a mean follow-up of 42.3 months, correction of the deformity was good or excellent in 80.5% of cases and fair in 15.4%. Pain due to bunion disappeared in 94.3% of feet. Mean preop IM (angle) was 17.3 and postop was 7.9. Metatarsal-phalangeal angle improved from 42.4 to 15.9. Fusion was achieved in 6.8 weeks (average). Complications were: hypercorrection in 13 feet (2 required reoperation); recurrence of deformity in 10 feet (1 reoperation); central metatarsalgia in 8 feet. Neither infection nor nonunions were observed. Patient satisfaction was excellent or good in 92.7% of patients.

Conclusion: Proximal closing-wedge osteotomy of first metatarsal is a good technique for the treatment of hallux valgus with severe IM angle and normal PASA. It is an easy and reproducible technique with good results, low number of complications and a high rate of patient satisfaction