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 • Total Knee Arthroplasty (TKA) – – – –

in Advanced degenerative arthritis Malaligned mechanical axis  Realignment Compensation at ankle and/or subtalar joint Change of ankle pain

Ankle alignment

Knee(Lowextremity)

alignment

Chandler JT, Moskal JT. J Arthroplasty. 2004

Keenan MA et al. J Bone Joint Surg 1991 McLauren CAN et al. Foot Ankle 1989 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 • Demographics

• Divide into 5 subgroups

Age

69.6 (54~80)

Sex

M : F / 7 : 64

F/U period

9 months (6~17)

Duration of symptom

4 months (1~14)

• 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

Talar tilt

Tibial-ankle surface angle

Medial joint space

Mechanical axis Frontal tibial ground angle

Hindfoot alignment view angle

Tibial plateauplafond 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 Group V (Mean±SD) (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

0.30±3.40 Frontal tibial ground angle(°)

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 plateauplafond 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

p = 0.013

Change of Clinical Ankle pain

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

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Department of OS & Spine Center Kyung Hee University Hospital at Gangdong