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Differences in outcomes following total ankle replacement in patients with neutral alignment compared with tibiotalar
Robin M Queen1, Samuel B Adams, Nicholas A Viens
1Department of Orthopaedic Surgery, Duke University Medical Center, Box 3435, Durham, NC 27710
The Journal of Bone and Joint Surgery. American Volume
|November 8, 2013
Summary
Total ankle replacement enhances patient outcomes regardless of initial foot alignment. Achieving neutral alignment during surgery is key for improved function and reduced pain after total ankle arthroplasty.
Area of Science:
- Orthopaedic Surgery
- Biomechanical Engineering
Background:
- Coronal plane tibiotalar malalignment is debated as a contraindication for total ankle replacement.
- Preoperative alignment significantly impacts surgical planning and patient outcomes.
Purpose of the Study:
- To compare clinical outcomes and physical performance after total ankle replacement based on preoperative tibiotalar alignment.
- To evaluate the efficacy of total ankle replacement in patients with varying degrees of coronal malalignment.
Main Methods:
- 103 patients undergoing total ankle replacement were grouped by preoperative coronal plane alignment (excessive deformity, moderate valgus/varus, neutral).
- Clinical outcomes (AOFAS, FADI, SF-36) and physical performance (TUG, 4SST, walking speed) were assessed preoperatively and at 1 and 2 years post-surgery.
- Adjunctive procedures were utilized to achieve neutral postoperative alignment.
Main Results:
- Postoperative neutral alignment improved from 36.9% to 95% after total ankle replacement.
- Significant improvements were observed in AOFAS scores, SF-36 subscales, FADI, TUG, 4SST, and walking speed (p < 0.001).
- No significant differences in outcomes were found based on preoperative alignment, provided neutral alignment was achieved postoperatively.
Conclusions:
- Total ankle replacement yields significant clinical and functional improvements.
- Outcomes are independent of preoperative alignment when neutral alignment is achieved during arthroplasty.
- Restoring neutral coronal alignment is crucial for successful total ankle replacement outcomes.
