Change in Talar Translation in the Coronal Plane After Mobile-Bearing Total Ankle Replacement and Its Association with Lower-Limb and Hindfoot Alignment

Yi, Young; Cho, Jae-Ho; Kim, Ji-Beom; Park, Suyeon; Lee, Woo Chun

doi:10.2106/jbjs.15.01340

Cited by 29 publications

(31 citation statements)

References 21 publications

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“…In addition to tibial component alignment, hindfoot alignment is also crucial to balance the ankle after TAR. Yi et al 36 assessed 159 ankles (153 patients) who underwent mobile-bearing TAR and found that a valgus hindfoot was related to medial translation of the talus. In the present study, varus hindfoot alignment at revision surgery was more frequent than valgus hindfoot alignment.…”

Section: Discussionmentioning

confidence: 99%

“…The position of the talus in the coronal plane was assessed via the talar center migration (TCM; Figure 2B). 36 Patients were divided into 3 similar-sized talar translation groups based on the mean preoperative TCM: lateral (>mean TCM + 0.4 * standard deviation [SD]), neutral (within 0.4 * SD from mean TCM), and medial (<mean TCM − 0.4 * SD). The hindfoot moment arm (HMA) was defined as the distance between the calcaneal and tibial axis (hindfoot alignment view; Figure 2C).…”

Section: Methodsmentioning

confidence: 99%

“…1,24 Of note, a recent study indicated that talar translation in the coronal plane after mobile-bearing TAR may be accompanied by various complications. 36 However, the extent to which such additional freedom of movement might overload periarticular ligaments and lead to decreased clinical and radiographic outcomes following mobile-bearing TAR has not yet been determined.…”

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confidence: 99%

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Syndesmotic Overload in 3-Component Total Ankle Replacement

et al. 2019

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Background: Mobile-bearing total ankle replacement (TAR) potentially enables motion at the tibial implant–polyethylene insert (PI) interface. Such additional freedom of movement may overload periarticular ligaments and subsequently result in coronal translation of the talus. The aim of this study was to assess whether syndesmotic overload affects clinical and radiographic outcomes following mobile-bearing TAR and whether tibiofibular fusion is an effective treatment option. Methods: Thirty-one patients who underwent revision surgery for syndesmotic overload after mobile-bearing TAR were retrospectively analyzed. Clinical and radiographic outcomes were assessed before and after index TAR, preoperatively to revision surgery, and at the last follow-up after revision surgery. Computed tomography scans were also analyzed. Results: Ankles with lateral talar translation prior to revision surgery were about 10 times more likely to have valgus tibial implant position ( P = .003). A wide tibiofibular distance at the level of the syndesmosis after index TAR was associated with an increased hindfoot moment arm at revision surgery ( P = .025). Decrease of PI height at revision surgery and a PI fracture were evident in 10 (32%) and 4 (13%) cases, respectively. Talar cyst formation at revision surgery was evident in 12 (39%) cases. Tibiofibular fusion was effective in restoring function of the replaced ankle and providing pain relief. Conclusion: Syndesmotic overload impaired clinical and radiographic outcomes after mobile-bearing TAR. Proper implant positioning and additional realignment procedures may prevent overload of periarticular soft tissue structures after mobile-bearing TAR. Level of Evidence: Level IV, retrospective case series.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Syndesmotic Overload in 3-Component Total Ankle Replacement

et al. 2019

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“…3,6,14,22,28 Research has shown that the success of TAA highly depends on whether the surgeon is able to balance the hindfoot (eg, stable and neutral aligned). 23,29 In addition, accurate tibial and talar resection cuts, as well as a prosthesis design that restores native ankle biomechanics, were found to improve patient outcome and enhance the longevity of the implant. 15,16,27…”

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confidence: 99%

“…Coronal plane instability may occur over time, possibly resulting in soft tissue overload and cyst formation. 1,8,13,18,29 Theoretically, such complications could be avoided with the use of a fixed-bearing TAA system, as long as the position of the components is adjusted to the individual anatomy and kinematic of the ankle.…”

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confidence: 99%

Axial Rotational Alignment in Mobile-Bearing Total Ankle Arthroplasty

et al. 2020

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Background: The presence of an interface between the tibial component and the polyethylene insert (PI) in mobile-bearing total ankle arthroplasty (TAA) may allow the talus to adapt its axial position according to the patient’s anatomy. However, little is known about differences of the axial talar rotation between patients following mobile-bearing TAA. Therefore, the aim of this study was to assess the relative axial rotation between the talar and tibial component intraoperatively and after a minimum follow-up of 3 years following mobile-bearing TAA. Methods: The relative axial rotation between the talar and the tibial component was measured intraoperatively in a cohort of 58 patients who underwent mobile-bearing TAA. In addition, it was measured on weightbearing computed tomography (CT) scans in 48 patients after a mean of 6.3 (3.0-16.3) years following mobile-bearing TAA. The pre- and postoperative alignment of the ankle joint/tibial component and hindfoot assessed on conventional radiographs was correlated with the intra- and postoperatively determined relative axial rotation of the talar and tibial component. Results: The mean intra- and postoperative axial talar component position was 1.7 (range, 14 internal to 14 external) and 1.4 (range, 12 internal to 20 external) degrees toward internal when compared to the tibial component ( P = .960). The preoperative sagittal alignment of the distal tibia correlated with the intraoperatively determined relative axial rotation between the talar and the tibial component ( P = .019). Conclusion: The wide range of the relative axial rotation between the tibial and talar component suggests that it is crucial to allow the talus to intraoperatively find a position that corresponds to the patient’s individual anatomy. The fact that the range of axial rotation was similar after a minimum of 3 years measured under weightbearing conditions suggests that structural changes of the osteoarthritic ankle may be the main determining factors for the axial rotational position of the talus. Our findings improve current understanding of proper implant position during TAA. In addition, the current study provides a reliable method to assess the postoperative axial position of the prosthesis components. The high interindividual variability of the relative rotation between the tibial and talar component in the axial plane suggests that axial malpositioning following TAA may be a more common issue than currently expected. Our findings may help to improve the assessment of patients with persistent pain following TAA. Level of Evidence: Level III, comparative series.

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