Marengo Asia Hospital (Formerly Sunshine Global Hospital), Vadodaranr. Shreyas Vidhyalay, behind ICICI Bank, Lalbaug, Manjalpur, Vadodara, Gujarat 390004 / Marengo Asia Hospital (Formerly Sunshine Global Hospital), SuratDumas Rd, beside Big Bazar, Piplod, Surat, Gujarat 395007
Total Ankle Replacement
Staged H3 Ankle Replacement for Combined Ankle & Subtalar Arthritis
A staged approach to combined ankle and subtalar arthritis — fusing the subtalar joint first to protect the talus, then replacing the ankle with a Hintermann H3.
Patient Age
54 Years
MECHANISM
6 years of ankle pain
PRESENTATION
6 Years of Pain, Unable to Walk
APPROACH
Staged Subtalar Fusion, then H3 Ankle Replacement
01
Clinical Rationale
Combined ankle and subtalar arthritis carries a high risk of talar avascular necrosis if both are addressed together. The subtalar joint was fused first and the replacement performed six weeks later, allowing the talar blood supply to recover in between.
02
Surgical Approach
Surgery was staged to protect the talar blood supply. Stage one was a subtalar fusion via a lateral approach with gastrocnemius-soleus resection, joint preparation and fixation using two screws and bone grafts. Stage two, six weeks later, was the total ankle replacement through an anterior approach.
02
Imaging & Progression
Pre-operative imaging, staged intra-operative views and three-month range-of-motion results. Each slot maps to a CMS image field — drop in the matching consented file from the case folder.
#1
Staging the surgery helps augment blood supply to the talus between procedures.
#2
Avascular necrosis of the talus is common after simultaneous ankle replacement plus subtalar fusion.
#3
A subtalar fusion performed first protects the talus before the ankle is replaced.
#4
Range of motion improved markedly from pre-op to three months following the staged reconstruction.
04
Clinical Care Points
RIGHT SIDE
- i) Stage 1 — Subtalar fusion (lateral approach)
ii) Gastro-soleus resection + joint prep
iii) Fixation with 2 screws + bone grafts
iv) Stage 2 — H3 TAR via anterior approach
LEFT SIDE
-
| 35+ YEARS OF TRUST, CARE & EXCELLENCE
Staged H3 Ankle Replacement for Combined Ankle & Subtalar Arthritis
A staged approach to combined ankle and subtalar arthritis — fusing the subtalar joint first to protect the talus, then replacing the ankle with a Hintermann H3.
A 54-year-old woman with obesity had endured approximately six years of severe ankle pain and increasing difficulty walking. Her quality of life was affected by arthritis in both the ankle and the subtalar joint beneath it. Treating only one joint would have left a major source of pain and mechanical dysfunction unaddressed.
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