Ben Efrima,Agustin Barbero,Amit Benady,Yair Green Halimi,Adi Lichtenstein,Cristian Indino,Camilla Maccario,Federico Giuseppe Usuelli
{"title":"作为足部畸形矫正工具的全踝关节置换术:通过负重计算机断层扫描分析对内侧柱对齐适应性的影响。","authors":"Ben Efrima,Agustin Barbero,Amit Benady,Yair Green Halimi,Adi Lichtenstein,Cristian Indino,Camilla Maccario,Federico Giuseppe Usuelli","doi":"10.1177/10711007241274739","DOIUrl":null,"url":null,"abstract":"BACKGROUND\r\nWhile weightbearing computed tomography (WBCT) has been instrumental in analyzing total ankle arthroplasty (TAA) positioning, there is a notable gap in the literature regarding adaptive changes in the foot's medial column after TAA. This study aims to bridge this gap by comparing preoperative and postoperative alignments of the foot's medial column and analyzing if a correlation exists between TAA coronal alignment correction and medial column alignment adaptation.\r\n\r\nMETHODS\r\nSixty patients who underwent a lateral approach TAA for end-stage osteoarthritis (OA) between January 2021 and April 2023 were included in this retrospective study. Patients were divided into varus (n = 30) and valgus (n = 30) groups. Preoperative and postoperative WBCT scans were analyzed to measure medial column alignment. Statistical analysis evaluated alignment corrections and correlations.\r\n\r\nRESULTS\r\nBoth groups showed significant plantarflexion of the second tarsometatarsal (TMT) angle, with a median adaptation of -1 degree (IQR -3, 0; P < .01) in the valgus group and -1 degree (IQR -3, 0; P = .03) in the varus group. The varus group exhibited increased plantarflexion of the first TMT angle (median -1 degree, IQR -1, -2; P = .03). Both groups demonstrated increased adduction of the medial column. The talonavicular coverage angle adaptation averaged 7.2 ± 14 degrees (P < .01) in the valgus and 9 ± 12 degrees (P < .01) in the varus group. The talo-first metatarsal axial angle adaptation was 5 ± 13 degrees (P = .03) in the valgus group and 9.5 ± 15 degrees (P = .08) in the varus group.\r\n\r\nCONCLUSION\r\nWBCT analysis revealed significant medial column adaptation post-TAA in varus and valgus alignments. However, no correlation was found between hindfoot correction and forefoot adaptation, making it challenging to predict the need for additional realignment surgeries. Future studies should explore the relationship between tibiotalar correction and medial column alignment to improve outcomes and the influence of total ankle design on medial column adaptation.\r\n\r\nLEVEL OF EVIDENCE\r\nLevel III, retrospective case control study.","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"31 1","pages":"10711007241274739"},"PeriodicalIF":2.4000,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Total Ankle Arthroplasty as a Correction Tool for Foot Deformities: Analyzing the Impact on Medial Column Alignment Adaptation Through Weightbearing Computed Tomography.\",\"authors\":\"Ben Efrima,Agustin Barbero,Amit Benady,Yair Green Halimi,Adi Lichtenstein,Cristian Indino,Camilla Maccario,Federico Giuseppe Usuelli\",\"doi\":\"10.1177/10711007241274739\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BACKGROUND\\r\\nWhile weightbearing computed tomography (WBCT) has been instrumental in analyzing total ankle arthroplasty (TAA) positioning, there is a notable gap in the literature regarding adaptive changes in the foot's medial column after TAA. This study aims to bridge this gap by comparing preoperative and postoperative alignments of the foot's medial column and analyzing if a correlation exists between TAA coronal alignment correction and medial column alignment adaptation.\\r\\n\\r\\nMETHODS\\r\\nSixty patients who underwent a lateral approach TAA for end-stage osteoarthritis (OA) between January 2021 and April 2023 were included in this retrospective study. Patients were divided into varus (n = 30) and valgus (n = 30) groups. Preoperative and postoperative WBCT scans were analyzed to measure medial column alignment. Statistical analysis evaluated alignment corrections and correlations.\\r\\n\\r\\nRESULTS\\r\\nBoth groups showed significant plantarflexion of the second tarsometatarsal (TMT) angle, with a median adaptation of -1 degree (IQR -3, 0; P < .01) in the valgus group and -1 degree (IQR -3, 0; P = .03) in the varus group. The varus group exhibited increased plantarflexion of the first TMT angle (median -1 degree, IQR -1, -2; P = .03). Both groups demonstrated increased adduction of the medial column. The talonavicular coverage angle adaptation averaged 7.2 ± 14 degrees (P < .01) in the valgus and 9 ± 12 degrees (P < .01) in the varus group. The talo-first metatarsal axial angle adaptation was 5 ± 13 degrees (P = .03) in the valgus group and 9.5 ± 15 degrees (P = .08) in the varus group.\\r\\n\\r\\nCONCLUSION\\r\\nWBCT analysis revealed significant medial column adaptation post-TAA in varus and valgus alignments. However, no correlation was found between hindfoot correction and forefoot adaptation, making it challenging to predict the need for additional realignment surgeries. Future studies should explore the relationship between tibiotalar correction and medial column alignment to improve outcomes and the influence of total ankle design on medial column adaptation.\\r\\n\\r\\nLEVEL OF EVIDENCE\\r\\nLevel III, retrospective case control study.\",\"PeriodicalId\":12446,\"journal\":{\"name\":\"Foot & Ankle International\",\"volume\":\"31 1\",\"pages\":\"10711007241274739\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-09-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Foot & Ankle International\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/10711007241274739\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Foot & Ankle International","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10711007241274739","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Total Ankle Arthroplasty as a Correction Tool for Foot Deformities: Analyzing the Impact on Medial Column Alignment Adaptation Through Weightbearing Computed Tomography.
BACKGROUND
While weightbearing computed tomography (WBCT) has been instrumental in analyzing total ankle arthroplasty (TAA) positioning, there is a notable gap in the literature regarding adaptive changes in the foot's medial column after TAA. This study aims to bridge this gap by comparing preoperative and postoperative alignments of the foot's medial column and analyzing if a correlation exists between TAA coronal alignment correction and medial column alignment adaptation.
METHODS
Sixty patients who underwent a lateral approach TAA for end-stage osteoarthritis (OA) between January 2021 and April 2023 were included in this retrospective study. Patients were divided into varus (n = 30) and valgus (n = 30) groups. Preoperative and postoperative WBCT scans were analyzed to measure medial column alignment. Statistical analysis evaluated alignment corrections and correlations.
RESULTS
Both groups showed significant plantarflexion of the second tarsometatarsal (TMT) angle, with a median adaptation of -1 degree (IQR -3, 0; P < .01) in the valgus group and -1 degree (IQR -3, 0; P = .03) in the varus group. The varus group exhibited increased plantarflexion of the first TMT angle (median -1 degree, IQR -1, -2; P = .03). Both groups demonstrated increased adduction of the medial column. The talonavicular coverage angle adaptation averaged 7.2 ± 14 degrees (P < .01) in the valgus and 9 ± 12 degrees (P < .01) in the varus group. The talo-first metatarsal axial angle adaptation was 5 ± 13 degrees (P = .03) in the valgus group and 9.5 ± 15 degrees (P = .08) in the varus group.
CONCLUSION
WBCT analysis revealed significant medial column adaptation post-TAA in varus and valgus alignments. However, no correlation was found between hindfoot correction and forefoot adaptation, making it challenging to predict the need for additional realignment surgeries. Future studies should explore the relationship between tibiotalar correction and medial column alignment to improve outcomes and the influence of total ankle design on medial column adaptation.
LEVEL OF EVIDENCE
Level III, retrospective case control study.
期刊介绍:
Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers.
The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008.
The journal focuses on the following areas of interest:
• Surgery
• Wound care
• Bone healing
• Pain management
• In-office orthotic systems
• Diabetes
• Sports medicine