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Introduction/Purpose: The incidence of primary total ankle arthroplasty (TAA) in the treatment of end-stage ankle arthritis has increased substantially over the last decade. TAA may be performed alone or in conjunction with additional procedures including subtalar (ST) or triple arthrodesis as end-stage ankle arthritis is often associated with degenerative disease affecting neighboring joints. Prior literature has demonstrated that the ipsilateral hindfoot arthrodesis may increase the risk for revision after TAA and that simultaneous ST arthrodesis with TAA could result in significant short term clinical and radiologic improvements. However, there is limited research comparing staged versus simultaneous hindfoot arthrodesis with concomitant TAA. The purpose of this study is to compare the reoperation rates after TAA with simultaneous hindfoot arthrodesis versus staged hindfoot arthrodesis followed by TAA. Methods: Patients who underwent primary TAA from 2015-2022 were identified in the PearlDiver database using international classification of diseases (ICD) and current procedural (CPT) codes. Patients were only selected if they contained 1-year database follow-up after the index TAA. Patients were sorted into three cohorts: (1) primary TAA without any history of hindfoot arthrodesis (control), (2) those with staged hindfoot arthrodesis prior to TAA, and (3) those with hindfoot arthrodesis at the same time as TAA. Demographic characteristics including age, gender, and Charlson Comorbidity Index (CCI) were assessed for each cohort. The 1-year rate of reoperation and revision were the primary outcomes of this study. Univariate analysis using chi- square tests and student T-tests were performed to analyze any differences in patient demographics, comorbidities, and complications. Multivariate analysis using logistic regression was subsequently conducted to account for any confounding variables and covariates. Results: 9,912 patients underwent TAA without prior hindfoot arthrodesis, 297 patients underwent TAA with prior hindfoot arthrodesis and 174 with hindfoot arthrodesis concurrently with TAA. The incidences of reoperation (OR 3.52, 12.6% vs. 3.9%, P

Background: A uniplanar, varus-producing distal femur osteotomy (DFO) may improve patellar tracking by effectively medializing the tibial tubercle, decreasing the Q-angle, and reducing the dislocation vector on the patella. Indications: A 17-year-old female with 8° of genu valgum presented with 18 months of symptomatic left knee patellar instability episodes that limit her function. Technique Description: A lateral subvastus approach to the distal femur was performed. Medial patellofemoral ligament reconstruction (MPFL-R) was conducted up to the point of femoral-sided graft fixation. A lateral opening wedge DFO was made with a sagittal saw and osteotomes, with care taken to maintain the medial cortical hinge. After distraction of the osteotomy site and femoral head allograft wedge placement, the osteotomy was secured with a lateral distal femoral locking plate. Finally, femoral-sided graft fixation for the MPFL-R was completed. Results: There were no immediate complications after surgery. Surgical management led to improvement of the patient's patellar instability, which allowed return to the prior baseline level of function. Discussion/Conclusion: The senior author's preferred technique for a lateral opening wedge DFO in association with an MPFL-R is presented. A varus-producing DFO is a surgical option for patients with genu valgum and recurrent patellar instability who have failed conservative management. This case demonstrates the efficacy of a lateral opening wedge DFO in improving patellar tracking and improving knee function by resolving recurrent patellar instability episodes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.