Fluoroscopically Guided Flexible Osteotome Technique with Stepwise Corticotomy for Removal of a Well-Fixed Modular Tibial Stem During Revision Total Ankle Arthroplasty

Revision total ankle arthroplasty (TAA) frequently requires removal of well-fixed tibial components.Modular intramedullary stem systems provide strong metaphyseal and diaphyseal fixation but can present substantial challenges during revision surgery.Standard extraction techniques relying on axial traction may fail when significant osseous integration occurs.We describe a stepwise technique for removal of a well-fixed modular tibial stem utilizing fluoroscopically guided flexible osteotomes combined with distal and proximal anteromedial tibial corticotomies.This staged approach allows controlled disruption of the bone-implant interface, facilitating safe extraction while minimizing tibial bone loss and reducing the risk of iatrogenic fracture.