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

Takahiro YamashitaDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

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Kanto NagaiDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

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Noriyuki KanzakiDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

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Tetsuya YamamotoDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

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Kazuyuki IbarakiDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

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Daisuke ArakiDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

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Yuichi HoshinoDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

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Takehiko MatsushitaDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

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Ryosuke KurodaDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

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Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Corresponding author: Noriyuki Kanzaki, MD, PhD, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. (E-mail: kanzaki@med.kobe-u.ac.jp)