Introduction: With the recent advancement, total ankle arthroplasty has been performed more frequently for painful end-stage ankle arthritis. However the indications of total ankle arthroplasty have yet to be determined. There is no clear consensus regarding the use of total ankle arthroplasty in end-stage arthritis with severe varus talar tilt. The present study evaluated the surgical outcome of total ankle arthroplasty performed in the cases with varus talar tilt of more than 20 degrees within the mortise.

Material and Method: Among 33 TAAs that were performed at our institution by single surgeon between August 2006 and February 2008, 4 cases showed varus talar tilt of more than 20 degrees determined by tibio-talar angle on preoperative standing ankle AP radiograph. There were 2 males and females, their ages were 60, 74, 75 and 76 years old. All the patients were not able to walk more than 10 minutes. Preoperative AOFAS ankle/hindfoot scale were rated as 28, 57, 60 and 50. The degree of varus talar tilt for each patient was 23, 25, 29 and 27. In 2 cases only TAA was performed, while a calcaneal osteotomy and peroneus longus transfer to peroneus brevis was added for one case, and a dorsiflexion osteotomy of the first metatarsus for the other case to address combined or remaining deformity and instability.

Result: There was no postperative surgical complication such as wound problems or surgical infection. The tibio-talar angle measured at sixth month postoperatively was 4, 4, 2 and 3 degree for each patient. Neither instability nor loosening was shown for all the patients. Postoperative AOFAS score improved to 72, 86, 87 and 98 at sixth month after the surgery.

Conclusion: Total ankle arthroplasty could be performed safely in the cases with varus talar tilt of more than 20 degrees within the mortise, of which results were satisfactory. For successful surgery, preoperative and intraoperative evaluation of the deformed ankle should be done, and if necessary additional surgeries should be performed to address combined or remaining deformity and instability.