Differences in Outcomes Following Total Ankle Replacement in Patients with Neutral Alignment Compared with Tibiotalar Joint Malalignment

Background: Excessive tibiotalar malalignment in the coronal plane has been considered by some to be a contraindication to total ankle replacement. The purpose of the present study was to compare clinical outcomes and physical performance measures according to preoperative tibiotalar alignment. Methods: One hundred and three patients undergoing total ankle replacement were grouped according to coronal plane tibiotalar alignment. Seventeen patients had an excessive deformity (>15 of varus or valgus), twenty-one had moderate valgus alignment (5 to 15 of valgus), twenty-seven had moderate varus alignment (5 to 15 of varus), and thirty-eight had neutral alignment (<5 of varus or valgus). Outcome measures, including the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, the Foot and Ankle Disability Index (FADI), the Short Form-36 (SF-36), the timed up and go test (TUG), the four square step test (4SST), and walking speed, were assessed preoperatively and at one and two years after total ankle replacement. Results: Coronal plane alignment improved following the procedure, with 36.9 % of patients having neutral alignment preoperatively as compared with 95 % postoperatively. To achieve this alignment, adjunctive procedures, including deltoid ligament release, lateral ligament reconstruction, and posterior soft-tissue releases, were necessary. Significant improvements were seen for the Page: 3 AOFAS pain, function, alignment, and hindfoot scores (p < 0.001) and the SF-36 subscales of body pain, physical function, and role physical (p < 0.001) following total ankle replacement. Walking speed and the FADI, TUG, an