title: Total ankle replacement through a lateral approach: surgical tips.
abstract: OBJECTIVE
  Recently, the Zimmer Trabecular Metal Total Ankle Replacement (Zimmer TM TAR) was developed to be used through a lateral transfibular approach. The purpose of this paper is to describe the surgical technique and early outcomes of the TAR via the lateral approach using the Zimmer TM TARs.
  
  
  METHODS
  Sixty-seven patients underwent primary TAR using the Zimmer TM TAR between May 2013 and May 2015. Patients were clinically evaluated preoperatively and postoperatively at six and twelve months and annually using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot scores, visual analogue scale (VAS) pain score, and the Short Form Health Survey (SF-12) questionnaire. The minimum follow-up was 12 months.
  
  
  RESULTS
  The mean AOFAS hindfoot score increased from 32.8 preoperatively to 85.0 at the latest follow-up (p-value < 0.001). The mean VAS pain score decreased from 8.0 to 2.0 at the latest follow-up (p-value < 0.001). The Physical and Mental Health Composite Scale scores (PCS and MCS) of the SF-12 passed from a mean value of 30.2 preoperatively to 43.1 (p-value < 0.001) and from a mean value of 44.6 to 53.5 at the latest follow-up (p-value < 0.001), respectively.
  
  
  CONCLUSIONS
  We present our surgical tips and the early results of this prosthetic design which are encouraging. They could be useful as an adjunct to the manufacturer's surgical technique guidance for surgeons who utilize these implants.
authors.affiliation: CASCO, IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy.
authors.forename: Federico Giuseppe
authors.initials: FG
authors.lastname: Usuelli
authors.affiliation: CASCO, IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Indino
authors.affiliation: CASCO, IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy - Scuola di Specializzazione in Ortopedia e Traumatologia, Universita' degli Studi di Milano, Via della Commenda 10, 20122 Milan, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Maccario
authors.affiliation: CASCO, IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Manzi
authors.affiliation: Orthopaedics and Traumatology, University G. dAnnunzio, Chieti Pescara, Via dei Vestini, 66100 Chieti, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Salini