Correction of excessive intraarticular varus deformities in total knee arthroplasty is associated with deteriorated postoperative ankle function.,Knee Surgery, Sports Traumatology, Arthroscopy

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Correction of excessive intraarticular varus deformities in total knee arthroplasty is associated with deteriorated postoperative ankle function.
Knee Surgery, Sports Traumatology, Arthroscopy ( IF 3.8 ) Pub Date : 2019-11-27 , DOI: 10.1007/s00167-019-05812-9
Frank Graef _{1,

2} , R Falk ₃ , S Tsitsilonis ₁ , C Perka ₁ , R K Zahn ₁ , H Hommel _{1,

3}

Affiliation

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.

中文翻译：

全膝关节置换术中过度关节内翻畸形的矫正与术后踝关节功能恶化有关。

目的

这项研究的目的是证明内翻膝骨关节炎的肢体对正矫正程度是否与踝关节症状的增加有关，并确定有关矫正程度的临界值，高于此阈值可预见踝关节问题。

方法

回顾性分析了九十九例术前膝内翻畸形的全膝关节置换术患者。对患者进行了临床检查（膝关节评分，被遗忘的关节评分，足功能指数，膝盖和踝关节的运动范围，疼痛程度）以及影像学检查。平均随访时间为57个月。

结果

手术肢体对位矫正的程度与足功能指数密切相关（R = 0.91，p <0.05）。鉴于此，尽管术后关节线的方向有所改善，但较高程度的膝关节错位矫正与膝关节和踝关节的术后预后较差有关。随后，可以计算出关节炎内翻畸形的临界值（14.5°），在此之上，踝关节症状的患病率增加[OR = 15.6（3.2-77.2 95％CI p <0.05）]。此外，距骨下关节的ROM限制与踝关节的不良结局相关。