*Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
J Am Podiatr Med Assoc. 2022 Nov-Dec;112(6). doi: 10.7547/20-116.
It remains controversial whether satisfactory outcomes can be obtained following total ankle arthroplasty (TAA) without osteotomy in patients with severe varus ankle deformities. This study aimed to examine outcomes following TAA without concomitant osteotomies in patients with severe varus ankle alignment by comparing them with those in patients with neutral alignment.
Fifty-one patients (53 ankles; mean age, 71.4 ± 5.6 years) who underwent TAA using the TNK ankle prosthesis were examined (mean follow-up, 36.8 ± 17.8 months). Patients were allocated into groups according to the preoperative talar tilt (TT) angle: the neutral group (preoperative TT angle <10°; n = 37) and the varus group (preoperative TT angle ≥10°; n = 16). Outcome measures, including the Japanese Society for Surgery of the Foot scale, Self-Administered Foot Evaluation Questionnaire, ankle range of motion, and radiographic parameters, were assessed before surgery and at the final follow-up.
Significant improvements were observed in clinical and radiographic outcomes in both groups after surgery. Postoperative Japanese Society for Surgery of the Foot scale and subscale scores of pain and shoes in the Self-Administered Foot Evaluation Questionnaire were not significantly different between the groups, whereas subscale scores of function, social, and health were greater in the varus group than in the neutral group at the final follow-up. Radiographic parameters, including TT angle and tibial axis-medial malleolus (TMM) angle, improved postoperatively and were not significantly different between the neutral (mean TT angle, 0.5 ± 0.7°; mean TMM angle, 16.0 ± 4.6°) and varus (meanTT angle, 0.4 ± 0.7°; meanTMM angle, 17.0 ± 5.3°) groups at the final follow-up. To achieve neutral alignment, adjunctive procedures were required more often in the varus group.
Outcomes of TAA using the TNK ankle prosthesis were favorable in patients with severe varus ankle and in those with neutral ankle without concomitant osteotomy. Satisfactory outcomes could be achieved in patients with severe varus ankle alignment after TAA without concomitant osteotomy.
在严重内翻踝畸形患者中，行单纯踝关节置换术（TAA）而不进行截骨术是否能获得满意的结果仍存在争议。本研究旨在比较严重内翻踝对线患者与中立踝对线患者行 TAA 而不伴截骨术的结果。
51 例（53 足；平均年龄 71.4 ± 5.6 岁）患者接受了 TNK 踝关节假体的 TAA 治疗（平均随访 36.8 ± 17.8 个月）。根据术前距骨倾斜角（TT）将患者分为两组：中立组（术前 TT 角＜10°；n = 37）和内翻组（术前 TT 角≥10°；n = 16）。在术前和末次随访时评估日本足外科协会评分、自我管理足部评估问卷、踝关节活动范围和影像学参数等结果。
两组患者术后临床和影像学结果均显著改善。术后日本足外科协会评分和自我管理足部评估问卷中疼痛和鞋子的亚量表评分在两组间无显著差异，而功能、社会和健康的亚量表评分在内翻组中高于中立组。术后 TT 角和胫骨轴-内踝（TMM）角等影像学参数得到改善，且在中立组（平均 TT 角为 0.5 ± 0.7°；平均 TMM 角为 16.0 ± 4.6°）和内翻组（平均 TT 角为 0.4 ± 0.7°；平均 TMM 角为 17.0 ± 5.3°）间无显著差异。为达到中立对线，内翻组更常需要附加手术。
在严重内翻踝和中立踝患者中，使用 TNK 踝关节假体的 TAA 结果是有利的，无需行截骨术即可获得满意的结果。在严重内翻踝畸形患者中，TAA 术后无需行截骨术即可获得满意的结果。
