Outcomes of Ankle Arthroplasty with Preoperative Coronal-Plane Varus Deformity of 10º or Greater

2013 ◽  
Vol 95 (15) ◽  
pp. 1382-1388 ◽  
Author(s):  
Tomce Trajkovski ◽  
Ellie Pinsker ◽  
Anthony Cadden ◽  
Timothy Daniels
Keyword(s):  
Varus Deformity ◽  
Coronal Plane ◽  
Ankle Arthroplasty

scholarly journals Mechanical and Anatomical Axis in Total Ankle Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0008
Author(s):  
Ali-Asgar Najefi ◽  
Andrew Goldberg
Keyword(s):  
Lower Limb ◽  
Mechanical Axis ◽  
Normal Group ◽  
Total Ankle Arthroplasty ◽  
Coronal Plane ◽  
Patient Specific ◽  
Ankle Arthroplasty ◽  
Patient Specific Instrumentation ◽  
Significant Difference ◽  
Anatomical Axis

Category: Ankle Arthritis Introduction/Purpose: Inadequate correction of alignment in the coronal, sagittal or axial planes will inevitably lead to failure of the Total Ankle Arthroplasty (TAA). The mechanical axis of the lower limb (MAL), the mechanical axis of the tibia (MAT) and the anatomical axis of the tibia (AAT) are three recognized coronal plane measurements using plain radiography. The relationship between anatomical and mechanical axes depends on the presence of femoral or tibial deformities from trauma or inherited conditions, or previous corrective or replacement surgery. Ankle arthroplasty relies heavily on preoperative radiographs or CT scans and the purpose of this study was to assess whether MAL, MAT and AAT are the same in a cohort of patients upon which placement of TAA is considered. Methods: We analysed 75 patients operated on between 2015 and 2016 at a specialist tertiary centre for elective orthopaedic surgery. All patients had a pre-operative long leg radiograph. They were split into 2 groups. The first group had known deformity proximal to the ankle (such as previous tibial or femoral fracture, severe arthritis, or previous reconstructive surgery) and the second group had no clinically detectable deformity. The MAL, MAT and AAT were assessed and the difference between these values was calculated. Results: There were 54 patients in the normal group, and 21 patients in the deformity group. Overall, 25 patients(33%) had a difference between all three axes of less than 1 degree. In 33 patients(44%), there was a difference in one of the axes of ≥2 degrees. There was no significant difference between MAT and AAT in patients in the normal group(p=0.6). 95% of patients had a difference of <1 degree. There was a significant difference between the MAT and AAT in patients in the deformity group(p<0.01). In the normal group, 39 patients(73%) had a difference of <2 degrees between the AAT and MAL. In the deformity group, only 10 patients (48%) had a difference of <2 degrees.In fact, 24% of patients had a difference ≥3 degrees. Conclusion: Malalignment in the coronal plane in TAA may be an issue that we have not properly addressed. Up to 66% of patients without known deformity may have a TAA that is placed at least 1 degree incorrectly relative to the MAL. We recommend the use of full-length lower limb radiographs when planning a TAA in order to plan the placement of implants. The decision to perform extramedullary referencing, intramedullary referencing, or patient specific Instrumentation must be part of the pre-operative planning process.

scholarly journals Minimum 5 Year Follow-Up Evaluation of a Third Generation Fixed Bearing Total Ankle Arthroplasty with an Intramedullary Tibial Component and a Central Suclus Talus

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0027
Author(s):  
Evan M. Loewy ◽  
Robert B. Anderson ◽  
Bruce E. Cohen ◽  
Carroll P. Jones ◽  
W. Hodges Davis
Keyword(s):  
Tibial Component ◽  
Patient Reported Outcomes ◽  
Total Ankle Arthroplasty ◽  
Coronal Plane ◽  
Third Generation ◽  
Fixed Bearing ◽  
Ankle Arthroplasty ◽  
Patient Reported ◽  
The Mean

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has been shown to be a viable option in the treatment of end stage ankle arthritis (ESAA). Early reports demonstrated good results with intramedullary fixation implants. Third generation implants of this kind added a central sulcus to the talar component. This is a report of clinical follow up data from a prospectively collected database at a single US institution using a third generation fixed bearing total ankle arthroplasty implant with a stemmed tibial component and a talar component with a central sulcus. To our knowledge, this is the first report of 5 year follow up data for this implant. Methods: Patients undergoing primary TAA at a single institution by one of four fellowship trained orthopedic foot and ankle surgeons with a third generation fixed bearing implant consisting of an intramedullary stemmed tibial component and a sulcus talus that were at least 5 years postoperative were reviewed from a prospectively collected database. These patients were followed at regular intervals with history, physical examination and radiographs; multiple patient reported outcomes (PRO) measures were obtained. Primary outcomes included implant survivability and PRO scores. Secondary outcomes included coronal plane radiographic alignment (Medial distal tibial articular angle (MDTA) and talar tilt angle (TTA)), evaluation for osteolysis, and failure mode when applicable. All reoperation events were recorded using the Canadian Orthopedic Foot and Ankle Society (COFAS) Reoperations Coding System (CROCS). Results: 121 TAA with this implant were performed in 119 patients between 2010 and 2013; 64 met inclusion criteria. The mean age at surgery was 61.3 ± 10.0 years (range 38.7-84.3). The mean duration of follow up for living patients that retained both initial components at final follow-up was 6.1 ± 0.9 years (range 4.7 – 8.1 years). 26.6% of ankles had a preoperative MDTA and/or TTA greater than 10 degrees. There were 6 (9.4%) failures that occurred at a mean 2.0 ± 1.4 years postoperative. Two failures were due to deep infection. Only one failure was related to tibial component subsidence. One patient is currently scheduled for revision due to talar component subsidence. Conclusion: This cohort of TAA patients with minimum 5 year follow up using a third generation fixed bearing implant demonstrates acceptable implant survival, improved patient reported outcomes scores and maintenance of coronal plane alignment. These data also suggest tolerance of a larger preoperative deformity with improved implant design. To our knowledge, this is the first report with 5 year data on this implant. Continued follow up and reporting is needed to ensure that these favorable outcomes are maintained. Additionally, further investigation on acceptable coronal plane alignment correction with TAA is needed to determine the possible limitations of this procedure.

scholarly journals Tibial Torsion and Ankle Arthritis: Is External Tibial Rotation Associated with Varus Deformity in Patients with Ankle Arthritis?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0002
Author(s):  
Collin C. Barber ◽  
Teresa Hall ◽  
Tyler Madden ◽  
Parin D. Kothari ◽  
Monica LaPointe ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Standard Deviation ◽  
Lower Extremity ◽  
External Rotation ◽  
Varus Deformity ◽  
Tibial Rotation ◽  
Tibial Torsion ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
The Mean

Category: Ankle; Ankle Arthritis; Hindfoot Introduction/Purpose: The effect of tibial torsion on lower extremity mechanical alignment has been well studied in the literature, including its effect on lower extremity osteoarthritis. It has been suggested that external tibial torsion is associated with cavus hindfoot deformity and may lead to varus osteoarthritis of the ankle. To our knowledge, there are no studies investigating this relationship. The purpose of this study is to characterize the relationship of tibial torsion with ankle coronal plane deformity in patients with ankle arthritis. Methods: The study is a retrospective, cohort of 223 patients who have undergone total ankle arthroplasty at a single institution. Preoperative computerized tomography was used to measure tibial torsion and coronal deformity. Descriptive statistics and regression analysis were used to analyze the data. Results: Descriptive analysis of all 223 patients demonstrated a maximum of 23.9 degrees varus and 20.5 degrees valgus among all patients. The mean for varus deformity was 6.86 degrees with a standard deviation of +- 6.39. Tibial rotation was calculated at an average of 20.8 degrees external rotation, with a maximum of 15.2 degrees internal rotation and 59.5 degrees external rotation in all patients. Plotting overall coronal ankle tilt versus tibial torsion revealed overall varus deformity with R2 of 0.016. Regression analysis of all varus deformities against external tibial torsion revealed a R2 of 0.02. Varus deformity 1 standard deviation above the mean against external tibial torsion demonstrated a R2 of 0.072. Valgus deformity against external tibial torsion revealed a R2 of 6.75 x10-5. Conclusion: An association between external tibial torsion and varus ankle arthritis has been proposed in the literature. The results of our study did not show an association between tibial torsion and coronal deformity in ankle arthritis in all patients undergoing total ankle arthroplasty at our institution. A difference may exist in certain subgroups, such as patients with neuromuscular disorders, but further investigation will be necessary to determine this relationship.

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.

scholarly journals Mid-Term (4-10 year) Outcomes of INBONE I Total Ankle Arthroplasty with Deformity Analysis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Andrew Harston ◽  
James Nunley ◽  
Mark Easley ◽  
James DeOrio ◽  
Samuel Adams ◽  
...  
Keyword(s):  
Short Form ◽  
Total Ankle Arthroplasty ◽  
Coronal Plane ◽  
Consecutive Series ◽  
Ankle Arthroplasty ◽  
Sf 36 ◽  
Significant Difference ◽  
Patient Reported ◽  
Plane Deformity

Category: Ankle, Ankle Arthritis Introduction/Purpose: Concerns for limited coronal plane stability prompted the manufacturer and designers of the INBONE total ankle arthroplasty system to replace the original saddle-shaped talar component (INBONE I) with a sulcus-shaped talar component (INBONE II). Prior to the availability of the INBONE II talar component, numerous INBONE I total ankle replacements were performed. To our knowledge mid-term outcomes of INBONE I total ankle arthroplasty have not been reported. This study compares the mid-term outcomes of patients with and without preoperative coronal plane deformity who underwent total ankle replacement with the INBONE I prosthesis. In our opinion, the longer-term outcomes of the INBONE I prosthesis are important for patient and surgeon education. Methods: A consecutive series of patients, from May, 2007 to September, 2011, at a single institution who underwent total ankle arthroplasty with the INBONE I Total Ankle Arthroplasty (Wright Medical) were prospectively enrolled. Pain and patient- reported function were assessed preoperatively and at yearly follow-ups with use of a visual analog scale (VAS) for pain, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle- hindfoot score, the Short Musculoskeletal Function Assessment (SMFA), and the Short Form-36 (SF-36) Health Survey. We analyzed the data for complications, reoperations, and failures (defined as undergoing revision for exchange or removal of the metallic components for any reason). Patients were grouped according to coronal plane tibiotalar alignment (preoperative coronal plane malalignment of >10 degrees and <10 degrees deformity) and outcomes compared. Results: One-hundred fifty-five INBONE I prostheses were implanted in 151 patients, with minimum 4 year clinical and radiographic follow-up. Follow-up ranged from 48-113 months with an average of 67 months. There was significant (p<0.05) improvement in the VAS, AOFAS, SMFA, and SF-36 scores at most recent follow-up. Forty-five patients (29%) had 49 additional surgeries for impingement, loosening/subsidence, malalignment, ligament instability, polyethylene exchange, and/or infection. There were 14 implant failures with overall survivorship of 90.3%. There was no statistically significant difference in outcomes between patients with coronal plane deformity >10 degrees (47.7%) and <10 degrees (52.3%). Patients with >10 degrees had fewer reoperations (19 vs. 30) and fewer revisions (5 vs. 9) when compared to patients with <10 degrees deformity. Conclusion: Patients who underwent INBONE I total ankle arthroplasty demonstrated significant improvement in pain and patient-reported outcomes at a mean of 5.7 years post-operatively. The patients with preoperative coronal plane tibiotalar deformity had similar pain relief, function, and need for additional surgeries and revisions. Despite the presumed shortcomings of the INBONE I’s saddle-shaped talar design, this operation shows promising results, with or without deformity, at mid-term follow- up with survivorship of 90.3%.

scholarly journals An approach to determine the coronal plane deformity of the distal tibia intraoperatively in the treatment of tibial fracture with intramedullary nail fixation

2020 ◽  
Author(s):  
Yao Lu ◽  
Jie Yang ◽  
Yibo Xu ◽  
Teng Ma ◽  
Ming Li ◽  
...  
Keyword(s):  
Intramedullary Nail ◽  
Closed Reduction ◽  
Tibial Fracture ◽  
Varus Deformity ◽  
Entry Point ◽  
Coronal Plane ◽  
Joint Surface ◽  
Unaffected Side ◽  
Tibiotalar Joint ◽  
Plane Deformity

Abstract Background To develop a new approach to determine the existence of coronal plane deformity (valgus and varus) intraoperatively in the treatment of tibial fracture with closed reduction and intramedullary nail fixation. Methods A retrospective analysis was conducted by enrolling 33 consecutive patients with tibial fracture who underwent closed reduction and intramedullary nail fixation from January 2018 to January 2019 in our trauma center. There were 23 males and 10 females aged from 22 to 69 years old with an average of 41.3. The standard anteroposterior and lateral preoperative radiographs were performed routinely. After insertion of the tibial intramedullary nail through the standard entry point intraoperatively, the parallel relationship between the distal horizontal interlocking screw and the tibiotalar joint surface on the anteroposterior fluoroscopy was used to determine the occurrence of valgus or varus deformity of the distal tibial fragment. Results 33 patients were postoperatively followed up for 13 to 25 months (mean 18.7 months). The fractures achieved bone union in 4.3 months by average (ranging from 3 to 6 months). The lateral distal tibial angle (LDTA) of the unaffected side which is measured postoperatively was 87.3°-89.6 ° (average 88.7 °± 0.8°), and the LDTA of the affected side was 87.5°-90.4°(average 88.9°± 1.1°). There was no statistically significant difference between the unaffected side and the affected side (t=-1.865, p=0.068). The intraoperative measurement indicated 6 cases of valgus angulation and 3 cases of varus angulation deformities, and all the deformities were corrected accordingly during the surgery. According to the Olerud-Molander Ankle Score, the clinical outcomes demonstrated 22 excellent cases, 8 good cases, 2 fair cases, and 1 poor case of all the fractures at 12 months after surgery. Conclusion During closed reduction and intramedullary nail fixation for tibial fractures, the parallel relationship between the distal horizontal interlocking screw and the tibiotalar joint surface on the intraoperative anteroposterior films showed the better discriminative ability to determine the onset of valgus or varus deformity of the distal tibial fragment after the tibial intramedullary nail inserted through the standard entry point.Level of Evidence: Level IV, case series study.

scholarly journals How balanced is the knee when we start a total knee replacement?

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0016
Author(s):  
MJ McAuliffe ◽  
G Garg ◽  
JA Roe ◽  
A Vakili ◽  
SL Whitehouse ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lateral Displacement ◽  
Varus Deformity ◽  
Neutral Axis ◽  
Coronal Plane ◽  
Lateral Side ◽  
Maximum Extension ◽  
Soft Tissue Envelope ◽  
Medial Side ◽  
Total Knee

Objectives: Optimal coronal plane alignment for total knee arthroplasty (TKA) remains controversial. Understanding the pre-operative soft tissue status is important for optimizing the soft tissue envelope during TKA. The purpose of this study was to define the corrected, neutral (“pre-disease”) HKAA of end stage osteoarthritic knees prior to TKA and from this point measure the medial and lateral laxity of varus and valgus knees in maximum extension, 20 and 90° of flexion prior to TKA. Methods: We conducted an observational cohort study. During surgery, the lower limb was manipulated using computer navigation, prior to surgical releases, whilst observing the joint to ensure congruence to allow the limb weight-bearing axis to pass through the knee center in maximum extension, 20° and 90° of flexion. Coronal plane laxity was measured as medial and lateral displacement from this point and compared to published values for healthy subjects. Results: The corrected, neutral HKAA in 89 knees in maximum extension prior to TKA was -1.22° +/- 1.4°. The corrected HKAA in maximum extension was within +/- 3° of 0° in 91.0% of patients. 12.8% (10/78) of varus knees displayed a medial contracture. Of these 10 knees, five also displayed abnormal lateral laxity. In maximum extension, 19.2% (15/78) of knees had abnormally increased lateral laxity. 10 of these 15 knees did not have a medial contracture. The remaining 5 knees with increased lateral laxity or 6.4% (5/78) displayed a medial contracture. Lateral laxity increased significantly with increasing varus deformity. Medial laxity did not significantly decrease when comparing varus deformity of 5 -10° versus >10°. 29 Valgus knees were examined. In maximum extension and 20° of flexion 27.6% of subjects (8/29) and 6.9% (2/29) of subjects respectively had a lateral contracture. On the medial side abnormally increased laxity was seen in 40.7% (11/27) in maximum extension; 75% (21/28) in 20° and 0% in 90° of flexion. On the lateral side abnormally increased laxity was seen in 3.7% (1/27) in maximum extension; 3.6% (1/27) in 20° of flexion and 72.4% in 90° of flexion. Conclusion: Varus and valgus knees did not record a corrected, neutral HKAA at the opposite end of the 0 +/-3° range. Optimal TKA alignment might be better and more specifically defined by the corrected neutral axis of each knee. The majority of varus knees with deformity of up to 15° have neither a medial contracture nor abnormal lateral laxity when referenced to the neutral axis of the knee. Lateral laxity is a more consistent feature of the varus knee. In the valgus OA knee a lateral contracture is not present in most patients and typically only present in maximum extension. The pattern then reverses to an abnormal increase in lateral laxity in flexion for many subjects. The pattern on the medial side is for maximum soft tissue disturbance in 20° of flexion before normalising in 90° of flexion. These findings demonstrate potentially problematic scenarios for balancing the valgus OA knee. The patterns of contracture and laxity found are variable and correlate poorly to deformity.

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