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Department of OS & Spine Center Kyung Hee University Hospital at Gangdong
Change of ankle pain after Total Knee
Replacement Arthroplasty
Heui-Chul Gwak, Chang-Wan Kim, Jung-Han Kim,
Dong-Woo Jeong, Hyeong-Joo Lee
Department of Orthopedic Surgery, Busan Paik Hospital,
College of Medicine, Inje University, Busan, Korea
Department of OS & Spine Center Kyung Hee University Hospital at Gangdong
Change of ankle pain after Total Knee
Replacement Arthroplasty
Heui-Chul Gwak, Chang-Wan Kim, Jung-Han Kim,
Dong-Woo Jeong, Hyeong-Joo Lee
My disclosure is in the
Final AOFAS Mobile App.
I have no potential conflicts with
this presentation.
Department of OS & Spine Center Kyung Hee University Hospital at Gangdong
Introduction
Knee(Low-
extremity)
alignment
Ankle
alignment
Chandler JT, Moskal JT. J Arthroplasty. 2004
Keenan MA et al. J Bone Joint Surg 1991
McLauren CAN et al. Foot Ankle 1989
• Total Knee Arthroplasty (TKA)
– in Advanced degenerative arthritis
– Malaligned mechanical axis Realignment
– Compensation at ankle and/or subtalar joint
– Change of ankle pain
Department of OS & Spine Center Kyung Hee University Hospital at Gangdong
Methods and Materials
• 80 ankles (71 patients) – 2012.01 – 2013.12
– F/U period > 6months
– Bilateral: 9 / unilateral: 62
– PS type TKA by 1 surgeon
– Preoperative Dx.: Degenerative knee arthritis
– Prospective design
• Excluded group – Prev. operation d/t ankle lesion
– Frequent prev. ankle sprain
– Ligament laxity
– Trauma Hx.
– Systemic musculoskeletal disease(e.g. RA, gout)
Department of OS & Spine Center Kyung Hee University Hospital at Gangdong
Methods and Materials
Age 69.6 (54~80)
Sex M : F / 7 : 64
F/U period 9 months (6~17)
Duration of
symptom 4 months (1~14)
• Demographics • Divide into 5 subgroups
• Clinical evaluation
- VAS(Visual Analogue Scales) score
- AO-FAS(American Orthopaedic Foot & Ankle Society, ankle-hind foot rating scales)
- Short Form-36 Health Survey
Department of OS & Spine Center Kyung Hee University Hospital at Gangdong
Methods and Materials
• Radiologic evaluation
Mechanical axis
Talar tilt Tibial-ankle surface angle Medial joint space
Frontal tibial
ground angle
Hindfoot alignment
view angle
Tibial plateau-
plafond angle
Department of OS & Spine Center Kyung Hee University Hospital at Gangdong
Results
• Subgroups
Subgroups Character N=80
Group I Preop(-) same 62
Group II Preop(-) newly developed 5
Group III Preop(+) same 2
Group IV Preop(+) aggravation 6
Group V Preop(+) improved 5
• Clinical results
Group I
(Mean±SD)
Group II
(Mean±SD)
Group III
(Mean±SD)
Group IV
(Mean±SD)
Group V
(Mean±SD)
p-value
VAS 0 3.79±1.51 0 1.60±2.15 -1.80±1.86 0.029
AO-FAS 0 -16.6±6.26 0 -6.90±7.11 14.0±5.39 0.038
SF-36 0/0 -14.7±4.53/
-14.6±5.82
0/0 -4.4±1.89/
-4.0±2.31
6.3±3.21/
5.4±2.78
0.061
Department of OS & Spine Center Kyung Hee University Hospital at Gangdong
Radiologic Results
Group I
(Mean±SD)
Group II
(Mean±SD)
Group III
(Mean±SD)
Group IV
(Mean±SD)
Group V
(Mean±SD)
p-value
Mechanical
axis(°) 11.21±2.75 10.08±3.07 9.82±1.41 10.71±4.77 10.53±2.91 0.013
Talar tilt(°) 0.12±0.72 0.02±0.59 0.05±0.29 0.16±0.31 0.32±0.78 0.311
Tibial-ankle
surface
angle(°)
0.51±1.67 0.20±1.65 0.47±2.11 0.71±3.12 0.83±2.93 0.609
Medial
gutter(mm)
1.53±0.85 1.20±0.97 1.65±1.53 0.78±1.65 1.49±0.15 0.121
Medial
clear(mm)
0.67±0.75 0.33±1.63 0.23±0.92 0.54±1.49 0.29±0.58 0.325
Frontal tibial
ground angle(°) 0.30±3.40 1.16±2.61 0.78±3.11 0.28±3.03 1.02±4.38 0.652
Hindfoot
alignment
view angle(°)
5.84±2.06 2.96±3.08 2.23±1.63 4.52±2.38 0.95±0.35 0.047
Tibial plateau-
plafond
angle(°)
-0.03±2.81 -1.12±3.12 2.05±1.22 1.89±2.96 2.61±2.05 0.247
Department of OS & Spine Center Kyung Hee University Hospital at Gangdong
Results
• Regression Analysis
Change of
Clinical
Ankle pain p = 0.013
p = 0.003
• Correlation Analysis (Pearson & Spearman)
Mechanical
Axis
Hindfoot
Alignment
View Angle
Correlation Coefficient = 0.317
Department of OS & Spine Center Kyung Hee University Hospital at Gangdong
Discussion
• New developed & aggravated ankle pain after TKA(11
cases, 13.8%)
realignment of femorotibial axis
change of hindfoot alignment
inadequate compensation at ankle & subtalar joint
Department of OS & Spine Center Kyung Hee University Hospital at Gangdong
Conclusion
• Realignment of low ext. between before & after TKA
Affect on…
1) Change of Realignment of hindfoot
2) Change of Ankle pain
inadequate compensation at ankle & subtalar joint
cause new developed ankle pain
Great attention should be paid on TKA
Department of OS & Spine Center Kyung Hee University Hospital at Gangdong
Reference
1. Chandler JT and Moskal JT: Evaluation of knee and hindfoot alignment before and after total knee arthroplasty: a prospective analysis. J arthroplasty, 19: 211-216, 2004.
2. Cooke D, Scudamore A, Li J, Wyss U, Bryant T and Costigan P: Axial lower-limb alignment: comparison of knee geometry in normal volunteers and osteoarthritis patients. Osteoarthritis Cartilage, 5: 39-47, 1997. 3. Derek T, Cooker V, Harrison L, Bhan K, Scudamore A and Chaudhary AA: Analysis of limb alignment in the pathogenesis of osteoarthritis: a comparison of Saudi Arabian and Canadian cases. Rheumatol Int, 22: 160-164. Epub, 3, 2002. 4. Desme D, Galand-Desme S, Besse JL, Henner J, Moyen B and Lerat JL: Axial lower limb alignment and knee geometry in patients with osteoarthritis of the knee. Rev Chir Orthop Reparatrice Appar Mot, 92: 673-679, 2006. 5. Guichet JM, Javed A, Russell J and Saleh M: Effect of the foot on the mechanical alignment of the lower limbs. Clin Orthop Relat Res, 415: 193-201, 2003. 6. Hunt MA, Fowler PJ, Birmingham TB, Jenkyn TR and Giffin JR: Foot rotational effects on radiographic measures of lower limb alignment. Can J Surg, 49: 401-406, 2006. 7. Lee WC and Kang YH: Radiological analysis of the degenerative arthritis of the ankle. J Korean Foot Ankle Soc, 9: 135-139, 2005. 8. Mizu-uchi A, Matsuda S, Miura H, Higaki H, Okazaki K and Iwamoto Y: The effect of ankle rotation on cutting of the tibia in total knee arthroplasty. J Bone Joint Surg, 88-A: 2632-2636, 2006. 9. Pagenstert GI, Hintermann B, Barg A, Leumann A and Valderrabano V: Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res, 462: 156-168, 2007. 10. Saltzman CL, Salamon ML, Blanchard GM, et al: Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J, 25: 44-46, 2005. 11. Takakura Y, Tanaka Y, Sugimoto K, Tamai S and Masuhara K: Ankle arthroplasty. A comparative study of cemented metal and uncemented ceramic prostheses. Clin Orthop Relat Res, 252: 209-215, 1990. 12. Tanaka Y, Takakura Y, Hayashi K, Taniguchi A, Kumai T and Sugimoto K: Low tibial osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg, 88-B: 909-913, 2006. 13. Tetsworth K and Paley D: Malalignment and degenerative arthropathy. Orthop Clin North Am, 25: 367-377, 1994. 14. Bae SY, Kim HC, Park YS, Lee SE and Lee DS: Radiologic Evaluation of Change of Ankle Joint after Total Knee Arthroplasty. J Korean Foot Ankle Soc, 11: 135-140, 2007
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