Differences in outcomes following total ankle replacement in patients with neutral alignment compared with tibiotalar joint malalignment.

Journal Article (Journal Article)

BACKGROUND: Excessive tibiotalar malalignment in the coronal plane has been considered by some to be a contraindication to total ankle replacement. The purpose of the present study was to compare clinical outcomes and physical performance measures according to preoperative tibiotalar alignment. METHODS: One hundred and three patients undergoing total ankle replacement were grouped according to coronal plane tibiotalar alignment. Seventeen patients had an excessive deformity (>15° of varus or valgus), twenty-one had moderate valgus alignment (5° to 15° of valgus), twenty-seven had moderate varus alignment (5° to 15° of varus), and thirty-eight had neutral alignment (<5° of varus or valgus). Outcome measures, including the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, the Foot and Ankle Disability Index (FADI), the Short Form-36 (SF-36), the timed up and go test (TUG), the four square step test (4SST), and walking speed, were assessed preoperatively and at one and two years after total ankle replacement. RESULTS: Coronal plane alignment improved following the procedure, with 36.9% of patients having neutral alignment preoperatively as compared with 95% postoperatively. To achieve this alignment, adjunctive procedures, including deltoid ligament release, lateral ligament reconstruction, and posterior soft-tissue releases, were necessary. Significant improvements were seen for the Page: 3 AOFAS pain, function, alignment, and hindfoot scores (p < 0.001) and the SF-36 subscales of body pain, physical function, and role physical (p < 0.001) following total ankle replacement. Walking speed and the FADI, TUG, and 4SST scores also improved significantly (p < 0.001). Subgroup analysis demonstrated no significant differences in clinical outcomes and physical performance measures based on preoperative coronal plane alignment. CONCLUSIONS: Total ankle replacement improves clinical and functional outcomes independent of preoperative tibiotalar alignment when postoperative alignment is restored to neutral at the time of arthroplasty. LEVEL OF EVIDENCE: Therapeutic level IV. See Instructions for Authors for a complete description of levels of evidence.

Full Text

Duke Authors

Cited Authors

  • Queen, RM; Adams, SB; Viens, NA; Friend, JK; Easley, ME; Deorio, JK; Nunley, JA

Published Date

  • November 6, 2013

Published In

Volume / Issue

  • 95 / 21

Start / End Page

  • 1927 - 1934

PubMed ID

  • 24196462

Electronic International Standard Serial Number (EISSN)

  • 1535-1386

Digital Object Identifier (DOI)

  • 10.2106/JBJS.L.00404


  • eng

Conference Location

  • United States