Change in Talar Translation in the Coronal Plane After Mobile-Bearing Total Ankle Replacement and Its Association with Lower-Limb and Hindfoot Alignment

Y. Yi, J. Cho, Ji‐Beom Kim, Jaeyoung Kim, Suyeon Park, Woo-Chun Lee
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引用次数: 23

Abstract

Background: Mobile-bearing total ankle replacement (TAR) enables motion at the tibial implant-polyethylene insert interface. This motion could lead to coronal translation of the talus relative to the tibia and may affect radiographic outcome. We aimed to assess the translation of the talus before and after mobile-bearing TAR to determine whether translation of the talus after TAR is associated with coronal plane alignment of the lower limb and hindfoot as well as to investigate the complications associated with talar translation. Methods: In this retrospective cohort study, we enrolled 153 patients (159 ankles) with a minimum follow-up of 3 years who underwent mobile-bearing TAR. The location of the talus in the coronal plane was quantified with use of talar center migration (TCM) on anteroposterior radiographs both preoperatively and at postoperative intervals, and the relationship between them was investigated. Radiographic parameters in the coronal plane—including mechanical axis deviation (MAD), lateral distal tibial angle (LDTA), hindfoot alignment angle, and hindfoot moment arm—were measured. The relationship between TCM and radiographic parameters in the coronal plane was assessed in each group. The complications associated with talar translation were examined during the same period. Results: During the 36-month follow-up period, the postoperative TCM showed a strong relationship with the preoperative TCM. Moreover, MAD, LDTA, and hindfoot alignment were significantly related to talar translation (p < 0.01). Complications included medial malleolar impingement in 5 cases (including delayed medial malleolar fracture due to medial impingement in 2 cases), insert dislocation in 1 case, and edge-loading in 2 cases; all of the cases with complications demonstrated implant overhang with talar translation. Conclusions: Talar translation in the coronal plane after mobile-bearing TAR correlates with the preoperative talar translation. Talar translation arises from deformities of MAD, LDTA, and hindfoot alignment, and it may be accompanied by various complications, as observed on coronal radiography. Therefore, additional realignment procedures for coronal malalignment should be considered to prevent talar translation after mobile-bearing TAR. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
可移动全踝关节置换术后冠状面距骨平移的变化及其与下肢和后足对齐的关系
背景:可移动全踝关节置换术(TAR)可以在胫骨植入物-聚乙烯植入物界面上运动。这种运动可能导致距骨相对于胫骨的冠状移位,并可能影响影像学结果。我们的目的是评估距骨移位前后的距骨移位,以确定距骨移位后的距骨移位是否与下肢和后足的冠状面对齐有关,并研究距骨移位相关的并发症。方法:在这项回顾性队列研究中,我们招募了153例患者(159踝关节),随访时间至少为3年。采用距骨中心偏移(TCM)对距骨在冠状面内的位置进行量化,并探讨术前和术后间隔的正位x线片与距骨之间的关系。测量冠状面放射学参数,包括机械轴偏差(MAD)、胫骨远端外侧角(LDTA)、后足对准角和后足力矩臂。评估各组冠状面造影参数与中医的关系。与距骨平移相关的并发症在同一时期进行了检查。结果:在36个月的随访中,术后中医与术前中医表现出较强的相关性。此外,MAD、LDTA和后足对齐与距骨平移有显著相关(p < 0.01)。并发症包括内踝撞击5例(包括2例因内踝撞击导致迟发性内踝骨折),内嵌体脱位1例,边缘负荷2例;所有出现并发症的病例均表现为种植体悬垂伴距骨平移。结论:带活动物的TAR术后冠状面距骨平移与术前距骨平移相关。距骨平移是由MAD、LDTA和后足对齐畸形引起的,如冠状位摄影所观察到的,它可能伴有各种并发症。因此,应考虑对冠状面失调进行额外的调整程序,以防止在移动方位TAR后的距骨平移。证据等级:预后IV级。参见《作者说明》获得证据等级的完整描述。
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