Piga Camilo, Maccario Camilla, D'Ambrosi Riccardo, Romano Fausto, Usuelli Federico Giuseppe
Equipo de Tobillo y Pie, Hospital del Trabajador, Santiago, Chile.
Ortopedia della Caviglia e del Piede, Humanitas S.Pio X, Milano, Italia.
Foot Ankle Int. 2021 Jul;42(7):867-876. doi: 10.1177/1071100720985281. Epub 2021 Feb 1.
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.
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.
The average AOFAS, VAS, and SF-12 scores improved significantly postoperatively ( < .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 ( > .05).
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.
Prognostic Level III, retrospective cohort study.
在终末期踝关节骨关节炎的情况下，严重的冠状面畸形很常见。最近的文献表明，在越来越严重的冠状面畸形中，全踝关节置换术的适应证有扩大的趋势，当实现正确对线时显示出有希望的结果。然而，外翻情况下经腓骨外侧全踝关节置换术（LTTAR）的结果尚未得到广泛研究。我们旨在评估外翻畸形踝关节的LTTAR短期随访结果是否与无严重畸形的踝关节相似。
这项回顾性队列研究纳入了228例LTTAR。根据术前冠状面胫距角（TTS）将患者分为两组：中立位（冠状面畸形小于10度，209例患者）和外翻位（外翻大于10度，19例患者）。使用美国矫形足踝协会（AOFAS）评分、视觉模拟量表（VAS）、12项简短健康调查问卷12（SF-12）的身体和精神成分汇总项目进行临床评估。影像学评估包括踝关节正侧位X线片。并发症也进行记录并分为严重或轻微。最短随访时间为2年。
术后平均AOFAS、VAS和SF-12评分显著改善（P<.001），两组之间无差异。在最后的影像学随访中，外翻对线组与中立对线组在TTS、胫骨远端外侧角或胫骨远端前角方面没有显著差异（P>.05）。
外翻畸形病例的LTTAR在短期随访中实现并维持了矫正，与中立对线的踝关节相同。无论术前是否存在外翻畸形，临床结果均有显著改善。
预后III级，回顾性队列研究。
