The purpose of this study was to evaluate the
change in sagittal tibiotalar alignment after total ankle arthroplasty (TAA)
for osteoarthritis and to investigate factors affecting the restoration
of alignment. This retrospective study included 119 patients (120 ankles) who
underwent three component TAA using the Hintegra prosthesis. A total
of 63 ankles had anterior displacement of the talus before surgery
(group A), 49 had alignment in the normal range (group B), and eight
had posterior displacement of the talus (group C). Ankles in group
A were further sub-divided into those in whom normal alignment was
restored following TAA (41 ankles) and those with persistent displacement
(22 ankles). Radiographic and clinical results were assessed. Pre-operatively, the alignment in group A was significantly more
varus than that in group B, and the posterior slope of the tibial
plafond was greater (p <
0.01 in both cases). The posterior slope
of the tibial component was strongly associated with restoration
of alignment: ankles in which the alignment was restored had significantly
less posterior slope (p <
0.001). An anteriorly translated talus was restored to a normal position
after TAA in most patients. We suggest that surgeons performing
TAA using the Hintegra prosthesis should aim to insert the tibial
component at close to 90° relative to the axis of the tibia, hence
reducing posterior soft-tissue tension and allowing restoration
of normal tibiotalar alignment following surgery. Cite this article:
