Bipolar total ankle allograft reconstruction in end-stage rheumatoid arthritis

Rheumatoid arthritis (RA) commonly affects the foot and ankle, occasionally progressing to end-stage ankle arthritis with severe pain and disability. While ankle arthrodesis reliably relieves pain, it sacrifices motion and may accelerate adjacent joint degeneration. Total ankle replacement (TAR) preserves motion but raises concerns regarding implant longevity in younger patients. This report describes a biologic, motion-preserving alternative using bipolar osteochondral allograft reconstruction. A 43-year-old female with RA presented with a 2-year history of progressive left ankle pain and functional limitation, refractory to conservative care. She demonstrated an antalgic gait, less than 10° ankle motion, and ankylosis of the hindfoot and midfoot. Imaging revealed advanced ankle arthritis with mild varus alignment. The patient underwent bipolar osteochondral allograft TAR via an anterior approach using size-matched grafts secured with headless compression screws. Postoperatively, she remained non-weightbearing for 12 weeks, followed by progressive rehabilitation. Computed tomography at 3 months confirmed graft incorporation and stable fixation. At 8 months, the patient achieved independent ambulation without assistive devices and reported substantial pain relief that persisted at >3 years postoperatively. Bipolar osteochondral allograft reconstruction represents a viable, motion-preserving option for younger patients with end-stage RA ankle arthritis. Early outcomes demonstrate meaningful pain reduction and functional improvement. Graft viability remains critical to success, and advances in preservation techniques may improve long-term durability. Further studies are needed to evaluate survivorship and optimize patient selection.