Total Ankle Arthroplasty With Valgus Deformity

Abstract

Background: A substantial coronal plane deformity is common in the context of end-stage ankle osteoarthritis. Recent literature shows a trend toward extending the indication of total ankle arthroplasty in increasingly severe coronal deformities, showing promising results when correct alignment is achieved. Nevertheless, the results of lateral transfibular total ankle replacement (LTTAR) in valgus has not been extensively studied. We aimed to evaluate if the outcomes of LTTAR in ankles with valgus deformity were similar to those with no major deformity at short-term follow-up. Methods: This retrospective cohort study included 228 LTTARs. Patients were classified into 2 groups according to the preoperative coronal plane tibiotalar angle (TTS): neutral (less than 10 degrees of coronal deformity, 209 patients) and valgus (above 10 degrees of valgus, 19 patients). Clinical evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS), 12-Item Short Form Health Survey 12 (SF-12) regarding its Physical and Mental Component Summary items. The radiographic evaluation considered anteroposterior and lateral ankle radiographs. Complications were also registered and classified as major or minor. The minimum follow-up was 2 years. Results: The average AOFAS, VAS, and SF-12 scores improved significantly postoperatively ( P < .001), without differences between groups. At final radiographic follow-up, the valgus alignment group did not show significant differences with the neutral alignment group regarding TTS, lateral distal tibial angle, or anterior distal tibial angle ( P > .05). Conclusion: LTTAR in cases with valgus deformity achieved and maintained correction at short-term follow-up, as obtained in neutral alignment ankles. Clinical outcomes improved significantly regardless of preoperative valgus deformity. Level of Evidence: Prognostic Level III, retrospective cohort study.

A Novel Orthoplastic Reconstruction of Relapsed Clubfoot With Total Ankle Arthroplasty

“…However, more recent generations of TAA implants have improved the talar component, suggesting increased utility in patients with talar abnormalities [ 48 ]. Furthermore, TAA appears to be a superior option in patients with severe ankle dissonance versus AA and osteotomy [ 49 ].…”

Fast-Track for Total Ankle Replacement: A Novel Enhanced Recovery Protocol for Select Patients

“…Indications for ankle prosthesis have been expanded and refined, including also severe deformities in some case series. 38,52 Severe preoperative coronal malalignment makes TAR a more challenging procedure and can be considered a risk factor for worse outcomes or major complications, especially in inexperienced hands; this necessarily leads to greater caution in the perioperative period. Coronal alignment of the ankle was assessed through the preoperative anteroposterior radiograph.…”

“…26,40,47,55 The growing interest in recent years in this technique has led to the expansion of specific knowledges and different surgical approaches and implanted materials, with a redefinition of indications, also regarding complex cases and severe deformities. 1,16,38 Enhanced recovery after surgery programs, also called fast-track protocols, were first developed in bowel surgery to improve postoperative outcomes in patients undergoing colorectal surgery. 10 Given the proven benefit, enhanced recovery after surgery programs have been successfully implemented in different areas of surgery, and high-volume models have been developed in the last decade for hip and knee reconstruction in order to optimize the patient's perioperative management and care, using a multidisciplinary and individualized approach.…”

“…The growing interest in recent years in this technique has led to the expansion of specific knowledges and different surgical approaches and implanted materials, with a redefinition of indications, also regarding complex cases and severe deformities. 1,16,38…”