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Correction of excessive intraarticular varus deformities in total knee arthroplasty is associated with deteriorated postoperative ankle function

  • Frank GraefEmail author
  • R. Falk
  • S. Tsitsilonis
  • C. Perka
  • R. K. Zahn
  • H. Hommel
KNEE
  • 36 Downloads

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.

Keywords

Total knee arthroplasty Total knee replacement Ankle joint Osteoarthritis knee Interplay knee ankle 

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

Notes

Author contributions

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.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Funding

This study was performed without external funding.

Ethical approval

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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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Center for Musculoskeletal SurgeryCharité-University Medicine BerlinBerlinGermany
  2. 2.Berlin Institute of HealthBerlinGermany
  3. 3.Department of OrthopaedicsMärkisch-Oderland Hospital, Brandenburg Medical School Theodor FontaneWriezenGermany

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