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Tóm lại, thay thế khớp mắt cá chân vẹo IS năm tưởng để trở thành công miễn là tất cả các vấn đề liên quan có Been đã đề cập đúng TRONG phẫu thuật. Một nghiêng vẹo của mái Lớn hơn 30 ° IS Có lẽ đường biên giới cho Đạt được điều chỉnh đầy đủ và cân bằng của mắt cá chân | 10.1 Reconstruction of the Malaligned Ankle 137 f g h i j k m In summary replacement of an arthritic varus ankle is thought to be successful as long as all associated problems have been properly addressed during surgery. A varus tilt of the talus greater than 30 is probably borderline for achieving sufficient correction and balancing of the ankle and thus a contraindication for total ankle arthroplasty. Although not yet proven the use of an ankle system that provides intrinsic stability against inversion moments may have a better prognosis with respect to recurrent varus deformity but may also potentially experience more polyethylene wear and higher shear forces at the bone-implant interface. Proper aligning and balancing of the whole foot and ankle is therefore mandatory for success with any ankle prosthesis. Total ankle arthroplasty performed without attention to the deforming forces in the foot may result in varus tilting of the talus and early failure. 138 Chapter 10 What is Feasible b c d e f Fig. 10.2. The concentric varus ankle. This man 62 years of age and a very active golfer developed ankle osteoarthritis many years after recurrent sprains. The varus deformity was caused by erosion of the medial tibial plafond a varus heel and incompetence of the calcaneofibular ligament and consequent talar tilt a . The lateral view shows that the talus remained positioned within the ankle mortise and also a subluxation of the subtalar joint b . Four months after total ankle replacement and medial ligament release the varus malalignment of the heel persists in neutral c and tip-toe position d . In the mortise view the hindfoot is still in varus due to tilting of the calcaneus into varus and persistent subtalar instability that is the lateral opening of the subtalar joint e . The lateral view shows the subtalar pathology with persistent subluxation f 10.1 Reconstruction of the Malaligned Ankle 139 10.1.2 Valgus Malalignment Occasionally a valgus ankle may develop after a