Bilateral Total Ankle Arthroplasty

Patients with bilateral ankle arthritis are more likely to have primary osteoarthritis or secondary inflammatory arthritis than patients with unilateral ankle arthritis. Additionally, patients with bilateral ankle arthritis have a more debilitation condition with worse PROMs and health -related quality of life (HRQOL) than patients with unilateral ankle arthritis. Considerations for indicating a patient for bilateral TAA include the patient's age, bone health, comorbidities, concomitant procedures required (should not necessitate non-weight-bearing postoperative), home support, self -motivation, endurance to mobilize with bilateral postoperative immobilization, and surgeon and team experience. Perioperative considerations for bilateral TAA include regional anesthesia, thigh tourniquets with sequential deflation at least 5 minutes apart, tranexamic acid, parallel arm board(s) at the end of the table to increase the operating space, and immediate postoperative weight -bearing as tolerated in short leg casts, which has not been show to result in increased complication rates. There is limited literature evaluating bilateral TAA with studies limited to small retrospective analyses. However, in general, the literature supports both 1 -surgeon and 2 -surgeon team bilateral TAA as safe and effective with comparable improvements in PROMs, complications, reoperations, and prosthesis survival as unilateral TAA and 2 -stage bilateral TAA. The more robust bilateral knee and hip arthroplasty literature further highlights potential risks (increased intraoperative blood loss and thromboembolic events) and benefits (cost reduction, noninferior and even superior perioperative complication profiles, improved PROMs and satisfaction, shorter total recovery time, early rehabilitation, and less time away from employment) of bilateral arthroplasty when compared with unilateral or staged procedures. In conclusion, when performed under surgeon expertise in appropriately selected patients, simultaneous bilateral TAA is a safe and effective method for the treatment of bilateral end -stage ankle arthritis. However, larger studies should expand on the potential risks and benefits, specifically evaluating radiographic outcomes, further clinical outcomes, perioperative complications, surgery time, tourniquet time, length of hospitalization, recovery and rehabilitation time, days of work missed, overall cost, and others.