Total Ankle Arthroplasty as a Correction Tool for Foot Deformities: Analyzing the Impact on Medial Column Alignment Adaptation Through Weightbearing Computed Tomography.

BACKGROUND

While weightbearing computed tomography (WBCT) has been instrumental in analyzing total ankle arthroplasty (TAA) positioning, there is a notable gap in the literature regarding adaptive changes in the foot's medial column after TAA. This study aims to bridge this gap by comparing preoperative and postoperative alignments of the foot's medial column and analyzing if a correlation exists between TAA coronal alignment correction and medial column alignment adaptation.

METHODS

Sixty patients who underwent a lateral approach TAA for end-stage osteoarthritis (OA) between January 2021 and April 2023 were included in this retrospective study. Patients were divided into varus (n = 30) and valgus (n = 30) groups. Preoperative and postoperative WBCT scans were analyzed to measure medial column alignment. Statistical analysis evaluated alignment corrections and correlations.

RESULTS

Both groups showed significant plantarflexion of the second tarsometatarsal (TMT) angle, with a median adaptation of -1 degree (IQR -3, 0;

CONCLUSION

WBCT analysis revealed significant medial column adaptation post-TAA in varus and valgus alignments. However, no correlation was found between hindfoot correction and forefoot adaptation, making it challenging to predict the need for additional realignment surgeries. Future studies should explore the relationship between tibiotalar correction and medial column alignment to improve outcomes and the influence of total ankle design on medial column adaptation.

LEVEL OF EVIDENCE

Level III, retrospective case control study.

Déclaration de conflit d'intérêts

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Federico G. Usuelli receives consulting or advisory and speaking and lecture fees from Zimmer Biomet, Arthrex Inc, Episurf, Planmed Oy, Geistlich Pharma AG, and BRM Trust; consulting or advisory, employment, paid expert testimony and speaking and lecture fees from Paragon 28 Inc; and is a member of the editorial board of