Top

Published in:

01-12-2020 | Arthritis | Original Article

Sagittal Tibiotalar Alignment May Not Affect Functional Outcomes in Fixed-Bearing Total Ankle Replacement: A Retrospective Cohort Study

Authors: Natalie M. Nielsen, MD, Guilherme H. Saito, MD, Austin E. Sanders, BA, Scott J. Ellis, MD, Carolyn M. Sofka, MD, Constantine A. Demetracopoulos, MD

Published in: HSS Journal ® | Special Issue 2/2020

Abstract

Background

In total ankle replacement (TAR), correct positioning of the implant is crucial. Malposition of the components may increase contact pressures and diminish prosthesis survival. The effect of sagittal tibiotalar alignment on functional outcomes after fixed-bearing TAR remains unclear, however, and no studies have compared fixed-bearing implants with respect to the anteroposterior (AP) position of the talar component.

Questions/Purpose

The purposes of this study were (1) to evaluate the effect of sagittal tibiotalar alignment on functional outcomes in fixed-bearing TAR and (2) to compare post-operative sagittal tibiotalar alignment in two types of fixed-bearing implants.

Methods

In a retrospective analysis of 71 primary TARs performed at a single center, we studied the INBONE™ II Total Ankle System and the Salto Talaris^® Ankle. Radiographic measurements of the tibial axis–talus (T-T) ratio and the AP offset ratio were performed before and after surgery, respectively, and we evaluated Foot and Ankle Outcome Scores (FAOSs) and the 12-item Short Form Health Survey (SF-12) mental component summary (MCS) and physical component summary (PCS) scales pre-operatively and at 2 years after surgery. The Pearson correlation and independent-samples t test were used to evaluate differences in FAOSs, SF-12 MCS scores, and SF-12 PCS scores regarding post-operative sagittal alignment.

Results

Post-operative sagittal tibiotalar alignment was neutral in 39 ankles and anterior in 32 ankles. We observed no significant between-group differences in clinical outcome scores. Patients with a Salto Talaris Ankle prosthesis had a greater AP offset ratio (0.12) than patients with an INBONE II implant (0.05). However, the greater translation did not correlate with outcome scores.

Conclusion

At the 2-year follow-up, no correlation between the post-operative AP offset ratio and functional outcome scores was observed between the two fixed-bearing-implant groups. Further studies with longer follow-up are needed to determine whether the difference in sagittal alignment has an effect on functional outcomes in the long term.

Available only for authorised users

Barg A, Elsner A, Anderson AE, Hintermann B. The effect of three-component total ankle replacement malalignment on clinical outcome: pain relief and functional outcome in 317 consecutive patients. J Bone Joint Surg Am. 2011;93(21):1969–1978. https://doi.org/10.2106/JBJS.J.01415.CrossRefPubMed

Barg A, Elsner A, Chuckpaiwong B, Hintermann B. Insert position in three-component total ankle replacement. Foot Ankle Int. 2010;31(9):754–759. https://doi.org/10.3113/FAI.2010.0754.CrossRefPubMed

Braito M, Dammerer D, Reinthaler A, Kaufmann G, Huber D, Biedermann R. Effect of coronal and sagittal alignment on outcome after mobile-bearing total ankle replacement. Foot Ankle Int. 2015;36(9):1029–1037. https://doi.org/10.1177/1071100715583383.CrossRefPubMed

Cho J, Yi Y, Ahn TK, et al. 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. Bone Joint J. 2015;97B(11):1525–1532. https://doi.org/10.1302/0301-620X.97B11.33636.CrossRef

Datir A, Xing M, Kakarala A, Terk MR, Labib SA. Radiographic evaluation of INBONE total ankle arthroplasty: a retrospective analysis of 30 cases. Skelet Radiol. 2013;42(12):1693–1701. https://doi.org/10.1007/s00256-013-1718-0.CrossRef

Doets HC, Brand R, Nelissen RG. Total ankle arthroplasty in inflammatory joint disease with use of two mobile-bearing designs. J Bone Jt Surg Am. 2006;88(6):1272–1284. https://doi.org/10.2106/JBJS.E.00414.CrossRef

Espinosa N, Walti M, Favre P, Snedeker JG. Misalignment of total ankle components can induce high joint contact pressures. J Bone Joint Surg Am. 2010;92(5):1179–1187. https://doi.org/10.2106/JBJS.I.00287.CrossRefPubMed

Fukuda T, Haddad SL, Ren Y, Zhang L-Q. Impact of talar component rotation on contact pressure after total ankle arthroplasty: a cadaveric study. Foot Ankle Int. 2010;31(5):404–411. https://doi.org/10.3113/FAI.2010.0404.CrossRefPubMed

Gross CE, Hamid KS, Green C, Easley ME, DeOrio JK, Nunley JA. Operative wound complications following total ankle arthroplasty. Foot Ankle Int. 2017;38(4):360–366. https://doi.org/10.1177/1071100716683341.CrossRefPubMed

10.

Hunt KJ, Hurwit D. Use of patient-reported outcome measures in foot and ankle research. J Bone Jt Surg Am. 2013;118(16):e118(1–9). https://doi.org/10.2106/JBJS.L.01476.CrossRef

11.

King CM, Schuberth JM, Christensen JC, Swanstrom KM. Relationship of alignment and tibial cortical coverage to hypertrophic bone formation in Salto Talaris total ankle arthroplasty. J Foot Ankle Surg. 2013;52(3):355–359. https://doi.org/10.1053/j.jfas.2013.01.011.CrossRefPubMed

12.

Labek G, Thaler M, Janda W, Agreiter M, Stockl B. Revision rates after total joint replacement: cumulative results from worldwide joint register datasets. Bone Joint J. 2011;93-B(3):293–297. https://doi.org/10.1302/0301-620X.93B3.25467.CrossRef

13.

Lee K-B, Kim M-S, Park K-S, Cho K-J, Primadhi A. Effect of anterior translation of the talus on outcomes of three-component total ankle arthroplasty. BMC Musculoskelet Disord. 2013;14(1):260. https://doi.org/10.1186/1471-2474-14-260.CrossRefPubMedPubMedCentral

14.

Mani SB, Do H, Vulcano E, et al. Evaluation of the foot and ankle outcome score in patients with osteoarthritis of the ankle. Bone Joint J. 2015;97-B(5):662–667. https://doi.org/10.1302/0301-620X.97B5.33940.

15.

Nodzo SR, Miladore MP, Kaplan NB, Ritter C. Short to midterm clinical and radiographic outcomes of the Salto total ankle prosthesis. Foot Ankle Int. 2014;35(1):22–29. https://doi.org/10.1177/1071100713510497.CrossRefPubMed

16.

Ramaskandhan JR, Kakwani R, Kometa S, Bettinson K, Siddique MS. Two-year outcomes of MOBILITY Total Ankle Replacement. J Bone Joint Surg Am. 2014;96(7):e53.CrossRef

17.

Rippstein PF, Huber M, Naal FD. Management of specific complications related to total ankle arthroplasty. Foot Ankle Clin. 2012;17(4):707–717. https://doi.org/10.1016/j.fcl.2012.08.010.CrossRefPubMed

18.

Saltzman CL, Tochigi Y, Rudert MJ, McIff TE, Brown TD. The effect of agility ankle prosthesis misalignment on peri-ankle ligaments. Clin Orthop Relat Res. 2004;424:137–142.CrossRef

19.

Spirt AA, Assal M, Hansen ST. Complications and failure after total ankle arthroplasty. J Bone Joint Surg Am. 2004;86-A(6):1172–1178.CrossRef

20.

Tochigi Y, Rudert MJ, Brown TD, McIff TE, Saltzman CL. The effect of accuracy of implantation on range of movement of the Scandinavian Total Ankle Replacement. J Bone Jt Surgery Br. 2005;87-B(5):736–740. https://doi.org/10.1302/0301-620X.87B5.14872

21.

Tochigi Y, Suh J-S, Amendola A, Pedersen DR, Saltzman CL. Ankle alignment on lateral radiographs. Part 1: sensitivity of measures to perturbations of ankle positioning. Foot Ankle Int. 2006;27(2):82–87. https://doi.org/10.1177/107110070602700202.CrossRefPubMedPubMedCentral

22.

Usuelli FG, Maccario C, Manzi L, Tan EW. Posterior talar shifting in mobile-bearing total ankle replacement. Foot Ankle Int. 2016;37(3):281–287. https://doi.org/10.1177/1071100715610426.CrossRefPubMed

23.

Ware J, Kosinski M, Keller S. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–233.CrossRef

24.

Williamson ERC, Demetracopoulos CA, Ellis SJ. Conversion of ankle autofusion to total ankle replacement using the Salto XT revision prosthesis. Foot Ankle Surg. 2016;22(3):e11–e16. https://doi.org/10.1016/j.fas.2016.01.003.CrossRefPubMed

Title: Sagittal Tibiotalar Alignment May Not Affect Functional Outcomes in Fixed-Bearing Total Ankle Replacement: A Retrospective Cohort Study
Authors: Natalie M. Nielsen, MD
Guilherme H. Saito, MD
Austin E. Sanders, BA
Scott J. Ellis, MD
Carolyn M. Sofka, MD
Constantine A. Demetracopoulos, MD
Publication date: 01-12-2020
Publisher: Springer US
Keyword: Arthritis
Published in: HSS Journal ® / Issue Special Issue 2/2020
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI: https://doi.org/10.1007/s11420-019-09728-5

At a glance: The STEP trials

Springer Medicine

Sagittal Tibiotalar Alignment May Not Affect Functional Outcomes in Fixed-Bearing Total Ankle Replacement: A Retrospective Cohort Study

Abstract

Background

Questions/Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Special Issue 2/2020

The Clavicle Continues to Grow During Adolescence and Early Adulthood

Association of Claustrophobia and Anxiety with Cast Intolerance in Patients with Extremity Injuries

Correlation Between the PROMIS Pediatric Mobility Instrument and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS)

Recurrent Complement-Mediated Thrombotic Microangiopathy in a Patient with Systemic Lupus Erythematosus

Impact of Knee Injuries on Post-retirement Pain and Quality of Life: A Cross-Sectional Survey of Professional Basketball Players

A Silver Lining