Increased medial talar tilt may incite ankle pain and predispose ankle osteoarthritis after correction of severity of knee varus deformity among patients undergoing bilateral total knee arthroplasty: a prospective observation
Abstract Purpose Patients with varus knee osteoarthritis usually compensate at the ankle and typically walk with hindfoot valgus alignment. As the neutral weight-bearing axis of the lower limbs is restored with Total Knee Arthroplasty (TKA), ankle and hindfoot biomechanics also acutely change. This...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | Knee Surgery & Related Research |
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| Online Access: | https://doi.org/10.1186/s43019-024-00212-x |
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| author | Arghya Kundu Choudhury Shivam Bansal J. Pranav Balgovind S. Raja Tushar Gupta Souvik Paul Kshitij Gupta Roop Bhushan Kalia |
| author_facet | Arghya Kundu Choudhury Shivam Bansal J. Pranav Balgovind S. Raja Tushar Gupta Souvik Paul Kshitij Gupta Roop Bhushan Kalia |
| author_sort | Arghya Kundu Choudhury |
| collection | DOAJ |
| description | Abstract Purpose Patients with varus knee osteoarthritis usually compensate at the ankle and typically walk with hindfoot valgus alignment. As the neutral weight-bearing axis of the lower limbs is restored with Total Knee Arthroplasty (TKA), ankle and hindfoot biomechanics also acutely change. This study aims to investigate whether any ankle clinical-radiographical changes occur as a result of bilateral mechanical TKA in patients with bilateral Osteoarthritis knee at a minimum follow-up of 6 months. Methods The prospective observational study included 61 patients (122 knees) undergoing simultaneous bilateral TKA (mechanical alignment). Tibio-talar angle(TTA), tibial Anterior Surface angle (TAS), lateral distal tibial angle (LDTA), talar-tilt angle (TT), anatomical talocrural angle (aTC), ground surface and distal tibial plafond angle (GP), ground surface and an upper surface of talus angle (GT)and tibial plateau and tibial plafond angle (PP) were measured on long-film radiographs to look for changes in the ankle, whereas functional assessment was done using American Foot and Ankle Society (AOFAS), Foot and Ankle Disability Index (FADI), and Forgotten Joint (FJS-12) scores. Patients were sub-grouped based on the Hip-Knee-Ankle (HKA) axis, and the effect of the severity of knee varus on the ankles after TKA was also analyzed. The minimum follow-up was 6 months. Results A significant decrease in the tibial plateau-tibial plafond (PP), ground-tibial plafond (GP), and ground-talar dome (GT) angles was noted after TKA (p-value < 0.05). Postoperative functional parameters were comparable to the preoperative status except for FADI, which significantly improved (p-value-0.03). Sub-group analysis based on the severity of knee varus (HKA) revealed GT to be most significantly reduced (p-value-0.036), while the talar tilt (TT) increased (p-value-0.044). Functional outcomes of the ankles clinically improved with the correction of severe knee varus after TKA. At a mean follow-up of 13.2 months post-TKA, 7 out of 61 (11.4%) patients complained of post-TKA ipsilateral ankle pain. Conclusion Mechanically aligned bilateral TKA in severe varus deformity of the knee significantly decreases the GT angle but increases the varus tilt of the talus with lateral talar incongruency and under-coverage. Although the acute correction of severe knee varus deformity aligns the tibia more neutrally, resulting in an overall clinically evident improvement in ankle functional outcome, the increased varus talar tilt remains a deep concern. Level of Evidence Prospective, observational, comparative study Level II. |
| first_indexed | 2024-03-07T15:28:35Z |
| format | Article |
| id | doaj.art-502b2dbc281c4baab0ea23fe28577d00 |
| institution | Directory Open Access Journal |
| issn | 2234-2451 |
| language | English |
| last_indexed | 2024-03-07T15:28:35Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Knee Surgery & Related Research |
| spelling | doaj.art-502b2dbc281c4baab0ea23fe28577d002024-03-05T16:33:24ZengBMCKnee Surgery & Related Research2234-24512024-01-0136111210.1186/s43019-024-00212-xIncreased medial talar tilt may incite ankle pain and predispose ankle osteoarthritis after correction of severity of knee varus deformity among patients undergoing bilateral total knee arthroplasty: a prospective observationArghya Kundu Choudhury0Shivam Bansal1J. Pranav2Balgovind S. Raja3Tushar Gupta4Souvik Paul5Kshitij Gupta6Roop Bhushan Kalia7Centre of Robotics and Joint Replacement Surgery, Sarvodaya Hospital and Research CentreDepartment of Orthopaedics, All India Institute of Medical SciencesDepartment of Orthopaedics, All India Institute of Medical SciencesDepartment of Orthopaedics, All India Institute of Medical SciencesDepartment of Orthopaedics, All India Institute of Medical SciencesAMRI hospital, Department of OrthopaedicsDepartment of Orthopaedics, All India Institute of Medical SciencesDepartment of Orthopaedics, All India Institute of Medical SciencesAbstract Purpose Patients with varus knee osteoarthritis usually compensate at the ankle and typically walk with hindfoot valgus alignment. As the neutral weight-bearing axis of the lower limbs is restored with Total Knee Arthroplasty (TKA), ankle and hindfoot biomechanics also acutely change. This study aims to investigate whether any ankle clinical-radiographical changes occur as a result of bilateral mechanical TKA in patients with bilateral Osteoarthritis knee at a minimum follow-up of 6 months. Methods The prospective observational study included 61 patients (122 knees) undergoing simultaneous bilateral TKA (mechanical alignment). Tibio-talar angle(TTA), tibial Anterior Surface angle (TAS), lateral distal tibial angle (LDTA), talar-tilt angle (TT), anatomical talocrural angle (aTC), ground surface and distal tibial plafond angle (GP), ground surface and an upper surface of talus angle (GT)and tibial plateau and tibial plafond angle (PP) were measured on long-film radiographs to look for changes in the ankle, whereas functional assessment was done using American Foot and Ankle Society (AOFAS), Foot and Ankle Disability Index (FADI), and Forgotten Joint (FJS-12) scores. Patients were sub-grouped based on the Hip-Knee-Ankle (HKA) axis, and the effect of the severity of knee varus on the ankles after TKA was also analyzed. The minimum follow-up was 6 months. Results A significant decrease in the tibial plateau-tibial plafond (PP), ground-tibial plafond (GP), and ground-talar dome (GT) angles was noted after TKA (p-value < 0.05). Postoperative functional parameters were comparable to the preoperative status except for FADI, which significantly improved (p-value-0.03). Sub-group analysis based on the severity of knee varus (HKA) revealed GT to be most significantly reduced (p-value-0.036), while the talar tilt (TT) increased (p-value-0.044). Functional outcomes of the ankles clinically improved with the correction of severe knee varus after TKA. At a mean follow-up of 13.2 months post-TKA, 7 out of 61 (11.4%) patients complained of post-TKA ipsilateral ankle pain. Conclusion Mechanically aligned bilateral TKA in severe varus deformity of the knee significantly decreases the GT angle but increases the varus tilt of the talus with lateral talar incongruency and under-coverage. Although the acute correction of severe knee varus deformity aligns the tibia more neutrally, resulting in an overall clinically evident improvement in ankle functional outcome, the increased varus talar tilt remains a deep concern. Level of Evidence Prospective, observational, comparative study Level II.https://doi.org/10.1186/s43019-024-00212-xAnkle painTotal knee arthroplastyTotal knee replacementVarus talar tiltVarus incongruencyPost-TKA |
| spellingShingle | Arghya Kundu Choudhury Shivam Bansal J. Pranav Balgovind S. Raja Tushar Gupta Souvik Paul Kshitij Gupta Roop Bhushan Kalia Increased medial talar tilt may incite ankle pain and predispose ankle osteoarthritis after correction of severity of knee varus deformity among patients undergoing bilateral total knee arthroplasty: a prospective observation Knee Surgery & Related Research Ankle pain Total knee arthroplasty Total knee replacement Varus talar tilt Varus incongruency Post-TKA |
| title | Increased medial talar tilt may incite ankle pain and predispose ankle osteoarthritis after correction of severity of knee varus deformity among patients undergoing bilateral total knee arthroplasty: a prospective observation |
| title_full | Increased medial talar tilt may incite ankle pain and predispose ankle osteoarthritis after correction of severity of knee varus deformity among patients undergoing bilateral total knee arthroplasty: a prospective observation |
| title_fullStr | Increased medial talar tilt may incite ankle pain and predispose ankle osteoarthritis after correction of severity of knee varus deformity among patients undergoing bilateral total knee arthroplasty: a prospective observation |
| title_full_unstemmed | Increased medial talar tilt may incite ankle pain and predispose ankle osteoarthritis after correction of severity of knee varus deformity among patients undergoing bilateral total knee arthroplasty: a prospective observation |
| title_short | Increased medial talar tilt may incite ankle pain and predispose ankle osteoarthritis after correction of severity of knee varus deformity among patients undergoing bilateral total knee arthroplasty: a prospective observation |
| title_sort | increased medial talar tilt may incite ankle pain and predispose ankle osteoarthritis after correction of severity of knee varus deformity among patients undergoing bilateral total knee arthroplasty a prospective observation |
| topic | Ankle pain Total knee arthroplasty Total knee replacement Varus talar tilt Varus incongruency Post-TKA |
| url | https://doi.org/10.1186/s43019-024-00212-x |
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