Abstract
Purpose
The aim of this study was to demonstrate, whether the degree of limb alignment correction in varus knee osteoarthritis correlated with an increase in ankle symptoms and to define a cut-off value concerning the degree of correction above which to expect ankle problems.
Methods
Ninety-nine consecutive patients with preoperative intraarticular varus knee deformities who underwent total knee arthroplasty were retrospectively analyzed. Patients were examined clinically (Knee Society Score, Forgotten Joint Score, Foot Function Index, Range of Motion of the knee and ankle joint, pain scales) as well as radiologically. The mean follow-up time was 57 months.
Results
The degree of operative limb alignment correction strongly correlated with the Foot Function Index (R = 0.91, p < 0.05). Given this, higher degrees of knee malalignment corrections were associated with worse postoperative outcomes in the knee and ankle joint—despite postoperative improved joint line orientations. Subsequently, a cut-off value for arthritic varus deformities (14.5°) could be calculated, above which the prevalence of ankle symptoms increased manifold [OR = 15.6 (3.2–77.2 95% CI p < 0.05)]. Furthermore, ROM restrictions in the subtalar joint were associated with a worse outcome in the ankle joint.
Conclusions
When correcting excessive intraarticular varus knee osteoarthritis, surgeons have to be aware of possible postoperative ankle symptoms and should consider ankle deformities or decreased subtalar ROM before operative procedures.
Level of evidence
III.
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Abbreviations
- FFI:
-
Foot Function Index
- FJS:
-
Forgotten Joint Score
- FS:
-
Function Score
- HKA:
-
Hip knee angle
- KS:
-
Knee Score
- KSS:
-
Knee Society Score
- ROM:
-
Range of motion
- TKA:
-
Total knee arthroplasty
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FG: statistical and data analysis, established the study protocol, wrote the manuscript. RF: data analysis, critical revision of the manuscript. ST: data analysis, critical revision of the manuscript. CP: data analysis, established the study protocol, critical revision of the manuscript. RKZ: data analysis, critical revision of the manuscript. HH: data analysis, established the study protocol, critical revision of the manuscript.
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This study was performed without external funding.
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This study was carried out according to the laws and ethical standards of the local legal representative body and was approved by the local ethics committee of the Brandenburg state of Germany (approval number AS17(bB)/2015).
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Graef, F., Falk, R., Tsitsilonis, S. et al. Correction of excessive intraarticular varus deformities in total knee arthroplasty is associated with deteriorated postoperative ankle function. Knee Surg Sports Traumatol Arthrosc 28, 3758–3765 (2020). https://doi.org/10.1007/s00167-019-05812-9
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DOI: https://doi.org/10.1007/s00167-019-05812-9