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

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