title: Failure to restore sagittal tibiotalar alignment in total ankle arthroplasty: Its relationship to the axis of the tibia and the positioning of the talar component.
abstract: The purpose of this study was to evaluate the change in sagittal tibiotalar alignment after total ankle arthroplasty (TAA) for osteoarthritis and to investigate factors affecting the restoration of alignment. This retrospective study included 119 patients (120 ankles) who underwent three component TAA using the Hintegra prosthesis. A total of 63 ankles had anterior displacement of the talus before surgery (group A), 49 had alignment in the normal range (group B), and eight had posterior displacement of the talus (group C). Ankles in group A were further sub-divided into those in whom normal alignment was restored following TAA (41 ankles) and those with persistent displacement (22 ankles). Radiographic and clinical results were assessed. Pre-operatively, the alignment in group A was significantly more varus than that in group B, and the posterior slope of the tibial plafond was greater (p < 0.01 in both cases). The posterior slope of the tibial component was strongly associated with restoration of alignment: ankles in which the alignment was restored had significantly less posterior slope (p < 0.001). An anteriorly translated talus was restored to a normal position after TAA in most patients. We suggest that surgeons performing TAA using the Hintegra prosthesis should aim to insert the tibial component at close to 90° relative to the axis of the tibia, hence reducing posterior soft-tissue tension and allowing restoration of normal tibiotalar alignment following surgery.
authors.affiliation: Seoul Paik Hospital, No. 85 2-Ga, Jeo-Dong, Jung-Gu, Seoul, 100-032, Republic of Korea.
authors.forename: J
authors.initials: J
authors.lastname: Cho
authors.forename: Y
authors.initials: Y
authors.lastname: Yi
authors.affiliation: Bundang CHA Hospital, No. 351, Yatap-Dong, Bundang-Gu, Sungnam, Kyunggi-Do, 463-070, Republic of Korea.
authors.forename: T K
authors.initials: TK
authors.lastname: Ahn
authors.affiliation: Haeundae Paik Hospital, No. 875, Haeundae-Ro, Haeundae-Gu, Busan, 612-896, Republic of Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Choi
authors.affiliation: Yeung-Nam University Hospital, No. 170, Hyunchung-Ro, Nam-Gu, Daegu, 705-040, Republic of Korea.
authors.forename: C H
authors.initials: CH
authors.lastname: Park
authors.affiliation: Soonchunhyang University Medical Center, No. 59, Daesagwan-Ro, Yongsan-Gu, Seoul, 140-743, Republic of Korea.
authors.forename: D I
authors.initials: DI
authors.lastname: Chun
authors.affiliation: Asan Medical Center, Pungnap 2(i)-dong Songpa-gu Seoul, Republic of Korea.
authors.forename: J S
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Seoul Paik Hospital, No. 85 2-Ga, Jeo-Dong, Jung-Gu, Seoul, 100-032, Republic of Korea.
authors.forename: W C
authors.initials: WC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D058737:Arthroplasty, Replacement, Ankle / Q000379:methods*; D005260:Female; D006801:Humans; D016916:Joint Deformities, Acquired / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013628:Talus / Q000000981:diagnostic imaging / Q000473:pathology*; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology*; D016896:Treatment Outcome
keywords: Ankle alignment; Ankle joint; Osteoarthritis; Talus position; Total ankle arthroplasty; sagittal plane