Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea.
J Bone Joint Surg Am. 2018 May 16;100(10):835-842. doi: 10.2106/JBJS.17.00703.
Preoperative ankle coronal malalignment has been considered as a risk factor for poor outcomes and failure after total ankle arthroplasty. The present study evaluated whether intermediate to long-term outcomes of total ankle arthroplasty in ankles with preoperative varus and valgus malalignment (5° to 20°) are comparable with those with neutral alignment (<5°).
We enrolled 144 consecutive ankles that underwent primary total ankle arthroplasty (140 patients) using a mobile-bearing HINTEGRA prosthesis with a minimum follow-up of 4 years; the mean overall follow-up duration was 89 months (51 to 145 months). We divided all patients into 3 groups according to the preoperative coronal plane tibiotalar angle: the varus group (59 ankles, 5° to 20° of varus), the valgus group (34 ankles, 5° to 20° of valgus), and the neutral group (51 ankles, <5°). Patients in each group showed similar characteristics in mean age, sex, body mass index, and follow-up period.
The mean Ankle Osteoarthritis Scale pain and disability score, American Orthopaedic Foot & Ankle Society ankle-hindfoot score, Short Form-36 Physical Component Summary score, visual analog scale pain score, and ankle range of motion did not differ meaningfully among the 3 groups at the final follow-up. The final tibiotalar angle showed that the degree of coronal alignment of the varus group was significantly less corrected compared with the neutral group (p = 0.010). The varus group had significantly more concomitant procedures (42 procedures [71.2%]) compared with the neutral group (p = 0.003). The prevalence of major complications did not differ among the 3 groups (p = 0.124). The overall probability of implant survivorship was 91.1% (97.7% in the varus group, 81.1% in the valgus group, and 90.9% in the neutral group) at a mean follow-up of 7.3 years.
In the intermediate to long-term follow-up, mobile-bearing total ankle arthroplasty showed similarly good outcomes in patients with varus and valgus malalignment up to 20° compared with the neutral alignment group when neutrally aligned ankles were achieved postoperatively.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
术前踝关节冠状面对线不良已被认为是全踝关节置换术后预后不良和失败的危险因素。本研究评估了术前内翻和外翻畸形（5°至 20°）的全踝关节置换术的中期至长期结果是否与中立对线（<5°）的结果相当。
我们纳入了 144 例接受了使用移动平台 HINTEGRA 假体的初次全踝关节置换术（140 例患者）的连续踝关节，随访时间至少为 4 年；平均总随访时间为 89 个月（51 至 145 个月）。我们根据术前冠状面距骨跟骨角将所有患者分为 3 组：内翻组（59 例，内翻 5°至 20°）、外翻组（34 例，外翻 5°至 20°）和中立组（51 例，<5°）。每组患者的平均年龄、性别、体重指数和随访时间均相似。
在最终随访时，3 组的踝关节骨关节炎量表疼痛和残疾评分、美国矫形足踝协会踝关节后足评分、简化 36 健康调查量表生理成分综合评分、视觉模拟评分疼痛和踝关节活动度均无显著差异。最终距骨跟骨角显示，与中立组相比，内翻组的冠状对线角度明显矫正不足（p=0.010）。与中立组相比，内翻组有更多的伴随手术（42 例[71.2%]）（p=0.003）。3 组的主要并发症发生率无差异（p=0.124）。在平均 7.3 年的随访中，总体植入物存活率为 91.1%（内翻组为 97.7%，外翻组为 81.1%，中立组为 90.9%）。
在中期至长期随访中，当术后踝关节达到中立对线时，与中立对线组相比，内翻和外翻畸形达 20°的患者采用活动平台全踝关节置换术也能获得同样良好的结果。
治疗性 III 级。请参阅作者指南，以获取完整的证据等级描述。
