International Orthopaedics

, Volume 43, Issue 1, pp 243–249 | Cite as

Total ankle replacement: is pre-operative varus deformity a predictor of poor survival rate and clinical and radiological outcomes?

  • Federico Giuseppe UsuelliEmail author
  • Claudia Angela Di Silvestri
  • Riccardo D’Ambrosi
  • Annalisa Orenti
  • Filippo Randelli
Original Paper



The objective of this study was to compare survival rate and clinical and radiological outcomes of a cementless mobile-bearing total ankle replacement (TAR) between two groups of patients, affected by end-stage ankle arthritis, with or without a pre-operative varus deformity.


A total of 81 patients (81 ankles) were included in the study and divided in two groups. Group A, “varus” group, includes 11 patients with pre-operative varus deformity of more than 10 ° and group B, “neutral” group, includes 70 patients, with a varus/valgus deformity of less than 10 °. American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS), and Short Form (SF)-12 score were used to compare clinical outcomes. Radiological parameters, complications, and survival rate at last follow-up were also recorded.


In both groups, all clinical and radiological parameters improved after surgery (p < 0.05) without statistically significant difference. Complications were similar between two groups. Overall in three cases, an implant revision was necessary: 1 in group A (9%) at 3.1 years follow-up and 2 (3%) in group B at 3.8 years, without statistically significant difference (p > 0.001).


Severe varus malalignment should not be considered a contraindication for a mobile-bearing TAR. Nevertheless, TAR in severe deformity should be performed only by experienced surgeons.


Total ankle replacement Varus deformity Malalignment Coronal malalignment 


Compliance with ethical standards

Conflict of interest

Dr. Federico G. Usuelli reports personal fees from Geistlich and grants and personal fees from Zimmer, outside the submitted work.

Dr. Claudia A. Di Silvestri reports grants from Zimmer, outside the submitted work.

Dr. Riccardo D’Ambrosi, Dr. Annalisa Orenti, and Dr. Filippo Randelli declare that they have no conflict of interest.

Ethical approval and informed consent

All procedures were conducted according to the 1964 Declaration of Helsinki. Prior to participation in the study, all subjects signed an informed consent form. The Institutional Ethical Committee approval was received before performing the study.

This article does not contain any studies with animals performed by any of the authors.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.C.A.S.C.O.IRCCS Istituto Ortopedico GaleazziMilanItaly
  2. 2.Dipartimento di Scienze Biomediche per la SaluteUniversità degli Studi di MilanoMilanItaly
  3. 3.Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry “G.A. Maccacaro”University of MilanMilanItaly
  4. 4.Ortopedia e Traumatologia - Centro di Chirurgia dell’Anca e TraumatologiaI.R.C.C.S Policlinico San DonatoMilanItaly

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