Joint Preservation Surgery for Varus Ankle Arthritis with Large Talar Tilt

Area of Science:

• Orthopedic surgery
• Foot and ankle reconstruction
• Biomechanical analysis

Background:

• Varus ankle arthritis with significant talar tilt (TT) presents a surgical challenge for joint preservation.
• Weightbearing CT reveals 3D talar deformities in these cases.
• Posterior tibial tendon (PTT) transfer is explored for managing this condition.

Purpose of the Study:

• To evaluate clinical and radiographic outcomes of PTT transfer with bony realignment for varus ankle arthritis and large TT.
• To identify indications for PTT transfer in nonparalytic ankle arthritis.

Main Methods:

• Retrospective case series of 23 ankles with varus arthritis and TT > 7.5 degrees.
• Patients divided into improved (19) and unimproved (4) groups based on postoperative results.
• Analysis of clinical and radiographic parameters, including TT, Meary angle, and hindfoot alignment.

Main Results:

• The improved group showed significant, sustained improvements in TT, radiographic stage, Meary angle, and hindfoot alignment.
• The unimproved group experienced no improvement in these parameters, with progression to end-stage arthritis.
• A preoperative TT of 14.3 degrees was identified as a predictor of surgical failure.

Conclusions:

• PTT transfer combined with bony realignment is a viable option for varus ankle arthritis with TT < 14 degrees and hindfoot varus.
• Careful patient selection is crucial for successful joint preservation outcomes.
• This approach may help avoid more extensive reconstructive procedures.