Shih Han-Ting, Liao Wei-Jen, Tu Kao-Chang, Lee Cheng-Hung, Tang Shih-Chieh, Wang Shun-Ping
Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
Department of Food Science and Technology, HungKuang University, Taichung 43302, Taiwan.
J Clin Med. 2021 Aug 17;10(16):3624. doi: 10.3390/jcm10163624.
This study investigated the differences in ankle alignment changes after TKA in patients with varying preexisting ankle deformities. We retrospectively examined 90 knees with osteoarthritis and varus deformity in 78 patients who underwent TKA. Preoperative and postoperative radiographic parameters were analyzed. According to their preexisting ankle deformity, patients were assigned to the valgus or varus group. Overall, 14 (15.6%) cases were of preoperative valgus ankle deformity; the remainder were of preoperative varus ankle deformity. Hip-knee-ankle angle (HKA), tibial plafond-ground angle (PGA), and talus-ground angle (TGA) all exhibited significant correction in both groups; however, tibial plafond-talus angle (PTA) and superior space of ankle joint (SS) only changed in the varus group. The median PTA and SS significantly decreased from 1.2° to 0.3° ( < 0.001) and increased from 2.5 to 2.6 mm ( = 0.013), respectively. Notably, ∆PTA positively correlated with ∆HKA in the varus group ( = 0.247, = 0.032) but not in the valgus group. Between-group differences in postoperative PTA ( < 0.001) and ∆PTA ( < 0.001) were significant. The degree of ankle alignment correction after TKA differed between patients with preexisting varus and valgus ankle deformities. TKA could not effectively correct the preexisting ankle valgus malalignment.
本研究调查了不同程度的踝关节畸形患者全膝关节置换术（TKA）后踝关节对线变化的差异。我们回顾性分析了78例行TKA的骨关节炎合并内翻畸形患者的90个膝关节。分析术前和术后的影像学参数。根据患者术前存在的踝关节畸形情况，将其分为外翻组或内翻组。总体而言，14例（15.6%）患者术前存在踝关节外翻畸形；其余患者术前存在踝关节内翻畸形。两组患者的髋-膝-踝角（HKA）、胫骨平台-地面角（PGA）和距骨-地面角（TGA）均有显著矫正；然而，仅内翻组的胫骨平台-距骨角（PTA）和踝关节上间隙（SS）发生了变化。PTA中位数从1.2°显著降至0.3°（<0.001），SS从2.5mm增至2.6mm（=0.013）。值得注意的是，内翻组中∆PTA与∆HKA呈正相关（=0.247，=0.032），而外翻组中无此相关性。术后PTA（<0.001）和∆PTA（<0.001）的组间差异显著。术前存在踝关节内翻和外翻畸形的患者TKA后踝关节对线矫正程度不同。TKA不能有效矫正术前存在的踝关节外翻畸形。
