Ankle Arthroplasty-Does Preoperative Fixed Equinus Affect Patient-Reported Outcomes.

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Patient Outcomes Research

Background:

• Postoperative sagittal range of motion, especially dorsiflexion, is crucial for successful total ankle arthroplasty (TAA).
• Limited data exists on patient-reported outcomes for TAA in the presence of preoperative fixed equinus.
• Preoperative fixed equinus may impact functional recovery and patient satisfaction after TAA.

Purpose of the Study:

• To compare patient-reported outcomes of TAA in patients with preoperative fixed equinus versus those with neutral ankle alignment.
• To evaluate the impact of preoperative fixed equinus on functional scores and patient satisfaction following TAA.
• To determine if preoperative fixed equinus influences revision rates after TAA.

Main Methods:

• A single-surgeon, consecutive case cohort study was conducted.
• Patients undergoing primary TAA were identified from a joint registry, with outcomes prospectively recorded.
• Patients were classified as fixed equinus or neutral based on preoperative weightbearing lateral radiographs and clinical assessment. Foot and Ankle Outcome Scores (FAOS), Short Form-36 (SF-36), and patient satisfaction were analyzed.

Main Results:

• A total of 167 TAA cases were analyzed (147 neutral, 20 fixed equinus) with a mean follow-up of 81.7 months.
• The fixed equinus group was significantly younger (52.9 vs 63.9 years, p < .001).
• No significant differences were found in final FAOS scores, change from baseline, patient satisfaction, or revision rates between the groups. Stiffness was the only FAOS domain different at baseline (p=0.044).

Conclusions:

• Preoperative fixed equinus did not lead to a demonstrable postoperative difference in patient-reported outcomes or revision rates in this cohort.
• TAA can yield comparable outcomes for patients with and without preoperative fixed equinus.
• Further research with larger cohorts may be warranted to confirm these findings.