Effect of Coronal and Sagittal Alignment on Outcome After Mobile-Bearing Total Ankle Replacement

Background: Comparably high revision rates are reported after total ankle replacement (TAR). Therefore, further critical analysis of the influence of implant position on clinical outcome is necessary. Methods: We analyzed the reliability and predictive value of previously published pre- and postoperative coronal and sagittal parameters in routine ankle radiographs on the clinical outcome of 84 HINTEGRA total ankle replacements (Newdeal, Lyon, France; Integra, Plainsboro, New Jersey). Mean follow-up was 4.0 years, and 15.5% of the TARs had revision surgery. Results: Mean postoperative American Orthopaedic Foot & Ankle Society ankle-hindfoot score was 71.3; mean postoperative verbal rating scale for pain was 3.1; and mean postoperative ankle range of motion was 26.4 degrees. Most tested radiologic parameters showed moderate or high intra- and interobserver reliability. With the numbers available, no significant difference in clinical outcome for all tested radiologic parameters could be detected. Conclusion: Our results indicate that mild malalignment of TAR, as assessed on routine ankle radiographs, did not affect midterm clinical outcome after TAR. Further multicenter studies with longer follow-up are needed to support our findings.