title: The adult ball-and-socket ankle joint: surgical management of late ankle and subtalar arthritis.
abstract: BACKGROUND
  We review the surgical management of 4 adult patients with ball-and-socket ankle deformity who developed end-stage subtalar and/or ankle joint arthritis.
  
  
  METHODS
  We retrospectively reviewed a series of 4 adult patients with ball-and-socket ankle configurations who underwent surgical treatment for either end-stage tibiotalar or subtalar arthritis, with either subtalar arthrodesis or total ankle replacement (TAR). Clinical outcome, including subjective pain assessment, limitation of activities, and difficulty with shoe wear, were assessed at follow-up.
  
  
  RESULTS
  A total of 5 ankles in 4 patients were identified that met the inclusion criteria. There were 3 subtalar arthrodeses in 2 patients and 2 primary TARs in 2 patients. At an average follow-up of 30.5 (range = 17 to 59) months, there were no failures, although 1 patient who underwent TAR was considered an impending failure with aseptic component loosening. Of the 4 patients, 3 resumed normal activity with minimal pain and were very pleased with their overall outcome.
  
  
  CONCLUSIONS
  Standard surgical interventions for ankle and subtalar arthritis, such as total ankle arthroplasty and subtalar arthrodesis, can be successfully performed in patients with ball-and-socket ankles; clinical outcome and survivorship, however, may be inferior to that in patients with normal ankle configurations.
  
  
  METHODS
  Therapeutic, Level IV: Case Series.
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JSL, JKD) john.lewis@duke.edu.
authors.forename: John S
authors.initials: JS
authors.lastname: Lewis
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JSL, JKD).
authors.forename: James K
authors.initials: JK
authors.lastname: DeOrio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000601:surgery*; D001168:Arthritis / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods*; D058737:Arthroplasty, Replacement, Ankle / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013628:Talus / Q000601:surgery*; D016896:Treatment Outcome
keywords: arthritis; ball-and-socket ankle; deformity correction; total ankle replacement