Fibuloplasty: Distal fibular reconstruction performed in conjunction with ankle fusion conversion to implant arthroplasty

Ankle arthrodesis (AA) represents an effective, dependable procedure for the treatment of end-stage osteoarthritis of the ankle. While AA offers the benefits of pain relief and some preservation of function, it sacrifices ankle motion which over time may lead to progressive degeneration of the adjacent joints of the hindfoot. Historically, salvage options for failed or painful AA included revisional AA, tibiotalocalcaneal arthrodesis, pantalar arthrodesis, and amputation. More recently the conversion of AA to total ankle arthroplasty (TAA) has been shown to be a viable salvage option which, unlike early salvage options, restores motion and function to the ankle and may help to avoid the need for periarticular arthrodesis. A unique challenge faced with AA conversion to TAA includes instances where fibular resection was performed during the primary procedure. Previous studies have evaluated the viability of conversion to TAA in patients with AA and prior fibular resection, with most authors stating that the absence of the lateral malleolus is an absolute contraindication to TAA. In contrast, newer studies have reported success with various techniques to restore the lateral fibular strut and perform the conversion of AA to TAA. This case report describes a unique approach of AA conversion to TAA utilizing a custom, fibular prosthesis to restore lateral stability following prior AA with fibular resection.