Total ankle arthroplasty and coronal plane deformities

Abstract

Level IV. Retrospective study.

Osteotomies for Managing Varus and Valgus Malalignment with Total Ankle Replacement

“…8,9,[19][20][21][22][23][24][25][26] One cannot isolate many studies reporting on outcomes of TARs combined with osteotomies, as these procedures are part of the whole spectrum of surgery performed for ankles with greater than 10 coronal plane deformity. Doets and colleagues 20 reported on his series of 15 TARs in varus ankles, requiring a medial malleolar lengthening osteotomy.…”

“…A French study 25 reviewed the outcomes in 21 TARs with deformity of greater than 10 , all requiring additional procedures, many of which were osteotomies. Six (28%) of 21 ankles had residual postoperative deformity requiring further corrective surgery (osteotomies), whereas 3 TARs (14%) had already failed (requiring revision or fusion) at 3 years.…”

“…[3][4][5][6][7][8][9] Some surgeons have, however, expanded the indications of TAR to include ankles with preoperative deformity of 15 or more, performing adjunctive procedures to correct coronal plane alignment and stability (eg, subtalar or triple arthrodesis, osteotomies, soft tissue releases, and ligament reconstructions). [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] We present the rationale, surgical techniques, and outcomes of re-alignment osteotomies that have been described (ie, medial malleolus, fibula, distal or proximal tibia, calcaneus, first metatarsal) as adjunctive procedures performing TAR for deformed ankles. This article focuses on coronal plane deformities, but one has to bear in mind that ankle deformity rarely occurs in one plane only.…”

Clinical Outcomes Following Total Ankle Arthroplasty without Concomitant Osteotomy in Ankles with Severe Preoperative Varus Deformity: Comparison to Ankles with Preoperative Neutral Alignment

“…Therefore, it is considered essential to establish a neutrally aligned ankle after TAA for successful long-term outcomes and to prevent complications (4,11,21). Recently, several studies have shown that satisfactory outcomes can be obtained following TAA even in ankles with substantial preoperative coronal deformity (4,(9)(10)(11)(12). The key to achieving postoperative neutral alignment seems to be associated with additional procedures at the time of TAA.…”

“…However, experts are yet to arrive at a consensus on whether preoperative coronal deformity is associated with postoperative poor outcomes. Some authors reported that preoperative coronal malalignment was associated with poor outcomes (7,8) and others reported no association between preoperative coronal varus deformity and postoperative clinical outcomes (2,(9)(10)(11)(12). As a limitation, most previous studies performed simultaneous osteotomy at the time of TAA for ankles with severe varus coronal deformity.…”