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Correction of severe valgus osteoarthritis by total knee arthroplasty is associated with increased postoperative ankle symptoms
PURPOSE: The aim of this study was to assess the mid-term clinical outcome of the ankle joint after total knee arthroplasty (TKA) in high-grade valgus osteoarthritis. METHODS: In this case–control study, n = 36 patients with a preoperative mechanical tibiofemoral angle (mTFA) ≥ 15° who underwent TKA...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8866357/ https://www.ncbi.nlm.nih.gov/pubmed/32839848 http://dx.doi.org/10.1007/s00167-020-06246-4 |
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author | Graef, Frank Hommel, Hagen Falk, Roman Tsitsilonis, Serafeim Zahn, Robert Karl Perka, Carsten |
author_facet | Graef, Frank Hommel, Hagen Falk, Roman Tsitsilonis, Serafeim Zahn, Robert Karl Perka, Carsten |
author_sort | Graef, Frank |
collection | PubMed |
description | PURPOSE: The aim of this study was to assess the mid-term clinical outcome of the ankle joint after total knee arthroplasty (TKA) in high-grade valgus osteoarthritis. METHODS: In this case–control study, n = 36 patients with a preoperative mechanical tibiofemoral angle (mTFA) ≥ 15° who underwent TKA between December 2002 and December 2012 were included. The control group (mTFA < 15°) of n = 60 patients was created using case matching. Radiological [mechanical tibiofemoral angle (mTFA) and ankle joint orientation to the ground (G-AJLO)] and clinical parameters [Foot Function Index (FFI), Knee Society Score, Forgotten Joint Score, and Range of Motion (ROM)] were analysed. The mean follow-up time was 59 months (IQR [56, 62]). RESULTS: The degree of correcting the mTFA by TKA significantly correlated with the postoperative FFI (R = 0.95, p < 0.05), although the knee and ankle joint lines were corrected to neutral orientations. A cut-off value of 16.5° [AUC 0.912 (0.85–0.975 95% CI), sensitivity = 0.8, specificity = 0.895] was calculated, above which the odds ratio (OR) for developing ankle symptoms increased vastly [OR 34.0 (9.10–127.02 95% CI)]. ROM restrictions of the subtalar joint displayed a strong significant correlation with the FFI (R = 0.74, p < 0.05), demonstrating that decreased ROM of the subtalar joint was associated with aggravated outcomes of the ankle joint. CONCLUSIONS: In this study, higher degrees of leg axis correction in TKA were associated with increased postoperative ankle symptoms. When TKA is performed in excessive valgus knee osteoarthritis, surgeons should be aware that this might trigger the onset or progression of ankle symptoms, particularly in cases of a stiff subtalar joint. LEVEL OF EVIDENCE: III. |
format | Online Article Text |
id | pubmed-8866357 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-88663572022-03-02 Correction of severe valgus osteoarthritis by total knee arthroplasty is associated with increased postoperative ankle symptoms Graef, Frank Hommel, Hagen Falk, Roman Tsitsilonis, Serafeim Zahn, Robert Karl Perka, Carsten Knee Surg Sports Traumatol Arthrosc Knee PURPOSE: The aim of this study was to assess the mid-term clinical outcome of the ankle joint after total knee arthroplasty (TKA) in high-grade valgus osteoarthritis. METHODS: In this case–control study, n = 36 patients with a preoperative mechanical tibiofemoral angle (mTFA) ≥ 15° who underwent TKA between December 2002 and December 2012 were included. The control group (mTFA < 15°) of n = 60 patients was created using case matching. Radiological [mechanical tibiofemoral angle (mTFA) and ankle joint orientation to the ground (G-AJLO)] and clinical parameters [Foot Function Index (FFI), Knee Society Score, Forgotten Joint Score, and Range of Motion (ROM)] were analysed. The mean follow-up time was 59 months (IQR [56, 62]). RESULTS: The degree of correcting the mTFA by TKA significantly correlated with the postoperative FFI (R = 0.95, p < 0.05), although the knee and ankle joint lines were corrected to neutral orientations. A cut-off value of 16.5° [AUC 0.912 (0.85–0.975 95% CI), sensitivity = 0.8, specificity = 0.895] was calculated, above which the odds ratio (OR) for developing ankle symptoms increased vastly [OR 34.0 (9.10–127.02 95% CI)]. ROM restrictions of the subtalar joint displayed a strong significant correlation with the FFI (R = 0.74, p < 0.05), demonstrating that decreased ROM of the subtalar joint was associated with aggravated outcomes of the ankle joint. CONCLUSIONS: In this study, higher degrees of leg axis correction in TKA were associated with increased postoperative ankle symptoms. When TKA is performed in excessive valgus knee osteoarthritis, surgeons should be aware that this might trigger the onset or progression of ankle symptoms, particularly in cases of a stiff subtalar joint. LEVEL OF EVIDENCE: III. Springer Berlin Heidelberg 2020-08-24 2022 /pmc/articles/PMC8866357/ /pubmed/32839848 http://dx.doi.org/10.1007/s00167-020-06246-4 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Knee Graef, Frank Hommel, Hagen Falk, Roman Tsitsilonis, Serafeim Zahn, Robert Karl Perka, Carsten Correction of severe valgus osteoarthritis by total knee arthroplasty is associated with increased postoperative ankle symptoms |
title | Correction of severe valgus osteoarthritis by total knee arthroplasty is associated with increased postoperative ankle symptoms |
title_full | Correction of severe valgus osteoarthritis by total knee arthroplasty is associated with increased postoperative ankle symptoms |
title_fullStr | Correction of severe valgus osteoarthritis by total knee arthroplasty is associated with increased postoperative ankle symptoms |
title_full_unstemmed | Correction of severe valgus osteoarthritis by total knee arthroplasty is associated with increased postoperative ankle symptoms |
title_short | Correction of severe valgus osteoarthritis by total knee arthroplasty is associated with increased postoperative ankle symptoms |
title_sort | correction of severe valgus osteoarthritis by total knee arthroplasty is associated with increased postoperative ankle symptoms |
topic | Knee |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8866357/ https://www.ncbi.nlm.nih.gov/pubmed/32839848 http://dx.doi.org/10.1007/s00167-020-06246-4 |
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