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