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