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Postoperative Medial Gutter Impingement Following Primary Total Ankle Arthroplasty: A Retrospective Case-Control
Joaquin Palma1,2, Grace DiGiovanni1, Seif El Masry1
1Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Background:
Medial gutter impingement may compromise the results of an otherwise well-fixed total ankle arthroplasty (TAA), but no previous study has assessed predisposing factors. This case-control study sought to investigate potential risk factors and the role of talar component downsizing in decreasing medial impingement.
Methods:
A retrospective case-control study with 149 patients was performed. Thirty-four patients reoperated for medial impingement were identified and matched to a control group of 115 patients. Radiographic parameters included pre- and post-TAA coronal alignment, talar center of migration ratio (TCMr), joint line height ratio (JLHR), and absolute talar component rotation (aTR). Demographic and radiographic data were compared. A logistic regression model assessed the correlation between medial gutter impingement with radiographic parameters and talar component downsizing.
Results:
Talar component downsizing was more frequent in the control group (70.4% vs 29.4%, P < .001). Postoperative varus alignment (91.17 vs 90.45 degrees, P = .012), a more elevated joint line (JLHR = 1.64 vs 1.5, P = .037), increased medial talar translation (TCMr = 10.66% vs 6.65%, P = .018), and internal talar rotation (aTR = 3.58 vs 0.24 degrees, P < .001) were observed in the medial impingement cohort. Regression analysis showed a negative correlation between talar downsize and the probability of medial impingement (OR = 0.18, 95% CI 0.07, 0.44, P < .001). A positive correlation was observed between medial impingement and a medially translated talar component (OR = 1.07, 95% CI 1.01, 1.15, P = .03) and a higher joint line level (OR = 1.23, 95% CI 0.99, 1.51, P = .051).
Conclusion:
Talar component downsizing correlated with an 82% reduction in the probability of medial gutter impingement. Postoperative varus alignment, an elevated joint line level, and medially translated and internally rotated talar component were more prevalent in patients reoperated for medial impingement.
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