To Stage or Not to Stage, the TAA Dilemma

by Vince Vacketta, DPM

Deformity correction in total ankle arthroplasty (TAA) has continued to expand with the advancements in instrumentation and surgeon training. While our ability to “save” ankles has improved, still many patients ultimately require peri-talar arthrodesis to achieve adequate deformity correction and complete symptomatic relief.

A recent retrospective comparative database study by Ramamurti et al. compared outcomes in patients who underwent simultaneous hind foot arthrodesis with TAA to those who had staged TAA + arthrodesis and their matched controls. The results showed statistically significant poor outcomes in the simultaneous group.

On the other hand, Hinterman et al. responded to this article by recognizing some difficulties with simultaneous procedures, but ultimately leaned towards endorsing the use of simultaneous arthrodesis, depending on the surgeon’s experience.

Despite ongoing debate, recent literature suggests better outcomes are staged procedures for TAA and hindfoot arthrodesis.