Effect of Total Knee Arthroplasty on Coronal Alignment of the Ankle Joint

Shichman, Ittai; Ben-Ari, Erel; Sissman, Ethan; Oakley, Christian T; Schwarzkopf, Ran

doi:10.1016/j.arth.2022.01.059

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…This may facilitate ankle osteoarthritis progression [ 31 ] and exacerbate ankle pain. Our study demonstrated decreased TPIA and TIA post-operation in both the MA-TKA and CM-TKA groups (Table 4 ), signifying restoration of the patient’s mechanical axis following the procedure; this finding differs from that of Shichman I et al [ 17 ]. However, knee varus correction ≥ 10 ° was associated with TTTA alterations (Table 4 ), corroborating Chang CB et al’s [ 16 ] report that ankle varus incongruence is aggravated.…”

Section: Discussioncontrasting

confidence: 78%

“…Shichman I et al [ 17 ] reported that knee valgus correction ≥ 10 ° affects ankle alignment and induces modifications in TPIA and TIA, while knee varus correction ≥ 10 ° and < 10 ° had no effect on TPIA and TIA. They also found that TKA did not impact TTTA.…”

Section: Discussionmentioning

confidence: 99%

“…Chang CB et al [ 16 ] reported that in patients whose knee varus deformity was corrected ≥ 10 ° following TKA, the degree of ankle varus incongruence was aggravated. Shichman I et al [ 17 ] revealed that A correction of ≥ 10 °in a genu valgum deformity can affect ankle joint alignment, leading to alterations in TPI and TI.…”

Section: Introductionmentioning

confidence: 99%

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MAKO robot-assisted total knee arthroplasty cannot reduce the aggravation of ankle varus incongruence after genu varus correction ≥ 10°: a radiographic assessment

Jin

Fan

Jiang

et al. 2023

BMC Musculoskelet Disord

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Introduction The objective of this study was to investigate the ankle alignment alterations after the correction of knee varus deformity in MAKO robot-assisted total knee arthroplasty (MA-TKA). Methods A retrospective analysis was conducted for 108 patients with TKA from February 2021 to February 2022. Patients were divided into two groups based on MAKO robot involvement during the procedure: the MA-TKA group (n = 36) and the conventional manual total knee arthroplasty (CM-TKA) group (n = 72). The patients were divided into four subgroups according to the degree of surgical correction of the knee varus deformity. Seven radiological measurements were evaluated pre and post-surgery: mechanical tibiofemoral angle (mTFA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), tibial plafond inclination angle (TPIA), talar inclination angle (TIA), and tibiotalar tilt angle (TTTA). TTTA is a quantitative representation of the extent of ankle incongruence. Results The number of mTFA, mLDFA, and MPTA outliers in the MA-TKA group was significantly lower compared to the CM-TKA group (P<0.05). Knee varus deformity was properly corrected and the mechanical axis was restored in all patients, regardless of the treatment group. Only for varus corrections ≥ 10° did TTTA change significantly (p < 0.01) and ankle varus incongruence aggravate post-operation. The ΔTTTA correlated negatively with ΔTFA (r=-0.310,P = 0.001) and correlated positively with ΔTPIA (r = 0.490,P = 0.000). When the varus correction was ≥ 7.55°, the probability of ankle varus incongruence exacerbation increased 4.86-fold. Conclusion Compared with CM-TKA, MA-TKA osteotomy showed more precision but was unable to reduce post-operation ankle varus incongruence. When the varus correction ≥ 10°, ankle varus incongruence aggravated, while when the varus correction ≥ 7.55°, the probability of ankle varus incongruence increased 4.86-fold. This may occasion the pathogenesis of ankle pain following TKA.

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Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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MAKO robot-assisted total knee arthroplasty cannot reduce the aggravation of ankle varus incongruence after genu varus correction ≥ 10°: a radiographic assessment

Jin

Fan

Jiang

et al. 2023

BMC Musculoskelet Disord

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“…In the present case, TKA was performed to address the patient's knee pain and walking difficulties due to severe genu valgum, leading to a notable 17°correction of the FTA. As knee and hindfoot alignment collaboratively affects the lower-limb mechanical axis, TKA-induced alterations in knee alignment are known to affect ankle alignment [11][12][13] . The impact of TKA on the ankle joint is evident in a study showing a high incidence of post-TKA degenerative ankle osteoarthritis 14 .…”

Section: Discussionmentioning

confidence: 99%

Peroneal Tendon Dislocation After Total Knee Arthroplasty in a Patient With Hereditary Multiple Exostoses

Ohba,

Uchio,

Maenohara

et al. 2023

JBJS Case Connector

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Case: We report a case of an 81-year-old woman with severe valgus deformity induced by hereditary multiple exostoses, which eventually led to the need for total knee arthroplasty (TKA) due to joint degeneration. Subsequently, she experienced peroneal tendon dislocation. Although changes in knee alignment can affect ankle joint alignment and reportedly lead to ankle pain after TKA, this is a rare case of nontraumatic peroneal tendon dislocation occurring after TKA. Conclusion: This case underscores the complexity of peroneal tendon dislocation after TKA where factors such as pre-existing anatomical abnormalities interact with the alignment changes induced by TKA.

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Varus knee osteoarthritis with ankle osteoarthritis demonstrates greater hindfoot inversion and larger ankle inversion loading during gait following total knee arthroplasty compared to varus knee osteoarthritis alone

Kikuchi,

Kanamori,

Kadone

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeAlthough patients with varus knee osteoarthritis (KOA) and concurrent ankle osteoarthritis (AOA) may experience increased ankle joint pain after total knee arthroplasty (TKA), the underlying mechanism remains unclear. This study aimed to investigate the effects of concurrent AOA on ankle and hindfoot alignment, frontal plane ankle and hindfoot biomechanics during gait following TKA and the clinical outcomes.MethodsTwenty‐four patients with varus KOA who underwent TKA were included in this retrospective cohort study. Patients were categorized into two groups: with and without AOA. Radiographic evaluations of lower‐limb, ankle and hindfoot alignment, and knee and ankle clinical outcomes were conducted preoperatively and 6 months postoperatively. In addition, gait analyses were performed to investigate knee, ankle and hindfoot kinematics and kinetics. Each data was compared between patients with and without AOA.ResultsConcomitant AOA was found in eight ankles. The AOA group exhibited greater postoperative hindfoot varus and increased postoperative ankle pain than the non‐AOA group. Gait analysis showed no significant differences in knee varus alignment or tibial tilt after TKA between the groups. However, the AOA group demonstrated significantly greater hindfoot inversion and larger ankle inversion loading.ConclusionOne third of patients who underwent TKA had concurrent AOA associated with hindfoot varus. Despite achieving proper coronal knee alignment postoperatively, these patients experienced greater hindfoot and ankle joint inversion load during gait. Surgeons should consider the inability to evert the hindfoot and the possibility of increased ankle joint pain when planning and performing TKA.Level of EvidenceLevel III.

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Effect of Total Knee Arthroplasty on Coronal Alignment of the Ankle Joint

Cited by 7 publications

References 20 publications

MAKO robot-assisted total knee arthroplasty cannot reduce the aggravation of ankle varus incongruence after genu varus correction ≥ 10°: a radiographic assessment

MAKO robot-assisted total knee arthroplasty cannot reduce the aggravation of ankle varus incongruence after genu varus correction ≥ 10°: a radiographic assessment

Peroneal Tendon Dislocation After Total Knee Arthroplasty in a Patient With Hereditary Multiple Exostoses

Varus knee osteoarthritis with ankle osteoarthritis demonstrates greater hindfoot inversion and larger ankle inversion loading during gait following total knee arthroplasty compared to varus knee osteoarthritis alone

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