Medial malleolar osteotomy for the correction of tibiotalar varus deformity during total ankle arthroplasty: Results in 95 ankles

The Foot ◽  
2022 ◽  
pp. 101905
Author(s):  
Laurens W. van der Plaat ◽  
H. Cornelis Doets ◽  
C. Niek van Dijk ◽  
Daniël Haverkamp
Keyword(s):  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Medial Malleolar Osteotomy

scholarly journals PROMS and Radiological Outcomes in Mobile Bearing Total Ankle Arthroplasty for Patients with Varus or Valgus Deformity

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0001
Author(s):  
Jack Allport ◽  
Adam Bennett ◽  
Jayasree Ramaskandhan ◽  
Malik Siddique
Keyword(s):  
Physical Health ◽  
Weight Bearing ◽  
Mobile Bearing ◽  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Ap Weight ◽  
Radiological Analysis

Category: Ankle Arthritis Introduction/Purpose: There is increasing evidence that outcomes for total ankle arthroplasty (TAA) are not adversely affected by pre-operative varus deformity. There is a sparsity of evidence relating to outcomes in valgus ankle arthritis. We present our outcomes using a mobile bearing prosthesis (Mobility TAA system, DePuy, Raynham, Massachusetts, USA) with a comparison of neutral, varus and valgus ankles. Methods: This is a single surgeon, retrospective cohort study of consecutive cases. Cases were identified from a locally held joint registry which routinely records PROMS data pre-operatively and at annual intervals. Patients undergoing primary TAA between March 2006 and June 2014 were included. Rrevision procedures along with those with inadequate radiographic images for deformity analysis were excluded. Patients with inadequate PROMS data were included in the radiological analysis but not the PROMS analysis. Data collected included FAOS (Womac Pain, Function and Stiffness), SF-36 scores and patient satisfaction. Radiological data was gathered from routinely taken AP weight bearing radiographs pre-operatively, immediately post-operatively and at final follow up. Pre-operative deformity was measured between the tibial anatomical axis and a line perpendicular to the talus. Patients were classified as neutral, varus (≥10 degrees varus) or valgus (≥10 degrees valgus). Results: 230 cases (see image) underwent radiological classification (152 neutral, 60 varus, 18 valgus) and were included in the radiological analysis (mean follow-up 55.9 months). 164 cases were included in the PROMS analysis (mean follow-up 61.6 months). The groups were similar with regards to BMI and length of follow-up but neutral ankles were younger (P<0.001). Baseline scores were equal except physical health with valgus ankles scoring lowest (P=0.045). Valgus ankles had statistically better post-operative pain (P=0.0247) and function (P=0.012) than neutral ankles. Pre to post-operative change did not reach statistical significance except physical health where valgus outperformed neutral and varus (p=0.039). Mean post-operative angle was 3.1 and final angle 3.7 with no significant differences. There was no significant differences in revision rates. Conclusion: Our study confirms previous evidence that varus deformity does not affect outcome in TAA. Contrary to this, valgus ankles in our cohort performed better post-operatively than neutral ankles. Post-operative coronal radiological alignment was not affected by pre-operative deformity and was maintained over a number of years. Coronal plane deformity does not negatively impact either radiological or clinical outcomes in TAA should not be considered an absolute contra-indication.

Hindfoot Alignment Change After Total Ankle Arthroplasty for Varus Osteoarthritis

2020 ◽  
pp. 107110072097093
Author(s):  
Hyuck Sung Son ◽  
Jung Gyu Choi ◽  
Jungtae Ahn ◽  
Bi O Jeong
Keyword(s):  
Ankle Joint ◽  
Case Series ◽  
Deformity Correction ◽  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Ankle Arthroplasty ◽  
End Stage ◽  
Surface Angle

Background: In patients with end-stage varus ankle osteoarthritis (OA), hindfoot varus malalignment resulting from the varus deformity of the ankle joint is common. Although total ankle arthroplasty (TAA) performed to correct varus deformity of the ankle joint has the effect of correcting hindfoot alignment, no reports to date have described how much hindfoot alignment correction can be achieved. The purpose of this study was to identify correlation between ankle deformity correction and hindfoot alignment change after performing TAA in patients with end-stage varus ankle OA. Methods: A total of 61 cases that underwent TAA for end-stage varus ankle OA and followed up for at least 1 year were enrolled for this study. Correlation between changes of tibial-ankle surface angle (TAS), talar tilt (TT), and tibiotalar surface angle (TTS) and changes of hindfoot alignment angle (HA), hindfoot alignment ratio (HR), and hindfoot alignment distance (HD) measured preoperatively and at postoperative year 1 was analyzed. Results: TAS, TT, and TTS changed from 83.9 ± 4.1 degrees, 5.8 ± 5.0 degrees, and 78.1 ± 5.9 degrees, respectively, before operation to 89.2 ± 2.1 degrees, 0.4 ± 0.5 degrees, and 88.7 ± 2.3 degrees, respectively, after operation. HA, HR, and HD also changed from −9.2 ± 4.6 degrees, 0.66 ± 0.18, and −11.2 ± 6.9 mm to −3.7 ± 4.1 degrees, 0.48 ± 0.14, and −5.0 ± 5.3 mm. All the changes were statistically significant ( P < .001, respectively). The regression slope of correlation was 0.390 ( R2 = 0.654) between TTS and HA; 0.017 ( R2 = 0.617) between TTS and HR; and 0.560 ( R2 = 0.703) between TTS and HD. Conclusion: In patients with end-stage varus ankle OA, changes of hindfoot alignment could be predicted based on degree of ankle deformity corrected with TAA. Level of Evidence: Level IV, case series.

Radiographic effects observed in the coronal view after medial malleolar osteotomy at total ankle arthroplasty in rheumatoid arthritis cases

2020 ◽  
Vol 25 (6) ◽  
pp. 1072-1078
Author(s):  
Makoto Hirao ◽  
Jun Hashimoto ◽  
Kosuke Ebina ◽  
Hideki Tsuboi ◽  
Koichiro Takahi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Medial Malleolar Osteotomy ◽  
Coronal View

Total Ankle Arthroplasty: Management of Varus Deformity at the Ankle

2012 ◽  
Vol 33 (4) ◽  
pp. 347-354 ◽  
Author(s):  
Daniel B. Ryssman ◽  
Mark S. Myerson
Keyword(s):  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty

scholarly journals Early Failure of Total Ankle Arthroplasty in a Patient with Ipsilateral Varus Knee Deformity

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Taehyeon Kim ◽  
Su Chan Lee ◽  
Chang Hyun Nam ◽  
Suengryol Ryu ◽  
Hye Sun Ahn ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Preoperative Diagnosis ◽  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Varus Knee ◽  
Early Failure ◽  
Ankle Arthroplasty ◽  
Multiple Risk Factors ◽  
Knee Deformity ◽  
Hindfoot Fusion

Multiple risk factors such as age, body mass index (BMI), preoperative diagnosis, smoking, diabetes mellitus, malalignment of an implant, and presence of ipsilateral hindfoot fusion have been shown to contribute to failure of total ankle arthroplasty (TAA). However, the exact causes of TAA failure remain uncertain, and various causes can lead to a need for revision surgery. We report a case of early aseptic loosening of the implant following TAA in a patient with severe varus deformity of the ipsilateral knee.

scholarly journals The risk factors of subsidence of the talar component in the 3 rd generation TNK ankle

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0036
Author(s):  
Shigeki Morita ◽  
Akira Taniguchi ◽  
Yasuhito Tanaka ◽  
Yoshinori Takakura
Keyword(s):  
Risk Factors ◽  
Cox Model ◽  
Articular Surface ◽  
Weight Bearing ◽  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Patient Specific ◽  
Ankle Arthroplasty ◽  
Tilting Angle ◽  
Before And After

Category: Ankle Arthritis Introduction/Purpose: One of the major reasons for revision surgeries after total ankle arthroplasty (TAA) was subsidence of the talar component. The purpose of this study was to evaluate mid-term outcomes after total ankle arthroplasty(TAA) using the 3 rd generation TNK ankle and investigate risk factors leading to subsidence of the talar component. Methods: Fifty consecutive patients who received the 3 rd generation TNK prosthesis between October 2007 and December 2014 were investigated in this study. Weight-bearing foot and ankle radiographies were taken and evaluated before and after surgery. At least 1 mm sinking of the talar component was defined as the subsidence. BMI, age at the surgery, complications were investigated as patient specific parameter and talar tilting angle(TTA) and inclination of the articular surface of the distal end of tibia were investigated as preoperative radiographic parameters. Position and angle of replaced implant were also investigated using postoperative radiography. Results: Preoperative TTA had positive correlation (p=0.049, Cox model), and the angle between the talar and the 1st metatarsal axis (Meary angle) had negative correlation with subsidence (p=0.042, Cox model). Conclusion: The larger TTA shows varus deformity of the ankle and indicates the potential instability of the ankle, that leads to frequent incidence of ankle sprain postoperatively. Repeated micro trauma causes the loosening and subsidence of the talar component. The smaller Meary angle shows the cavus deformity, that prevents the favorable load distribution to the navicular and calcaneus, and leads to higher pressure concentration to the implant. The larger TTA and smaller Meary angle were risk factors of subsidence of the talar component in the TAA.

Accuracy of CT-Derived Patient-Specific Instrumentation for Total Ankle Arthroplasty: The Impact of the Severity of Preoperative Varus Ankle Deformity

2022 ◽  
pp. 193864002110682
Author(s):  
Benjamin D. Umbel ◽  
Taylor Hockman ◽  
Devon Myers ◽  
B. Dale Sharpe ◽  
Gregory C. Berlet
Keyword(s):  
Case Series ◽  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Patient Specific ◽  
Level Of Evidence ◽  
Neutral Group ◽  
Ankle Arthroplasty ◽  
Patient Specific Instrumentation ◽  
Implant Alignment ◽  
The Impact

Background Significant preoperative varus tibiotalar deformity was once believed to be a contraindication for total ankle arthroplasty (TAA). Our primary goal was to evaluate the influence of increasing preoperative varus tibiotalar deformity on the accuracy of final implant positioning using computed tomography (CT)-derived patient-specific guides for TAA. Methods Thirty-two patients with varus ankle arthritis underwent TAA using CT-derived patient-specific guides. Patients were subcategorized into varying degrees of deformity based on preoperative tibiotalar angles (0°-5° neutral, 6°-10° mild, 11°-15° moderate, and >15° severe). Postoperative weightbearing radiographs were used to measure coronal plane alignment of the tibial implant relative to the target axis determined by the preoperative CT template. Average follow-up at the time of data collection was 36.8 months. Results Average preoperative varus deformity was 6.06° (range: 0.66°-16.3°). Postoperatively, 96.9% (30/31) of patients demonstrated neutral implant alignment. Average postoperative tibial implant deviation was 1.54° (range: 0.17°-5.7°). Average coronal deviation relative to the target axis was 1.61° for the neutral group, 1.78° for the mild group, 0.94° for the moderate group, and 1.41° for the severe group (P = .256). Preoperative plans predicted 100% of tibial and talar implant sizes correctly within 1 size of actual implant size. Conclusion. Our study supports the claim that neutral postoperative TAA alignment can be obtained using CT-derived patient-specific instrumentation (PSI). Furthermore, final implant alignment accuracy with PSI does not appear to be impacted by worsening preoperative varus deformity. All but one patient (96.9%) achieved neutral postoperative alignment relative to the predicted target axis. Level of Evidence: Level IV, Clinical Case Series

Sign in / Sign up

Export Citation Format

Share Document