Background: We investigated the association between hindfoot residual malalignment assessed on weightbearing computed tomography (WBCT) images and the development of periprosthetic cysts (PPCs) after total ankle replacement (TAR). We hypothesized that PPCs would be found predominantly medially in the varus configuration and laterally in the valgus configuration.
Methods: Cases of primary TAR with available WBCT imaging of the ankle were included in this retrospective study. The location of the PPC was marked and the following volumes were calculated: total (TCV), medial (MCV), central (CCV), and lateral (LCV) cyst volumes. Hindfoot alignment was measured as Foot and Ankle Offset (FAO), with 95% confidence intervals (95% CIs) calculated to define varus (<95% CI) and valgus (>95% CI) groups. Cyst volumes were compared between these 2 groups. The American Orthopaedic Foot & Ankle Society (AOFAS) score at the time of the WBCT was also retrieved. Receiver operating characteristic (ROC) curves were used to determine FAO thresholds for predicting an increased risk of PPC.
Results: Forty-eight TARs (mean follow-up, 44.6 months) were included, 81% of which had at least 1 PPC. The mean FAO was 0.12% (95% CI, -1.12 to 1.36). Patients with greater residual malalignment (P < .001) and those with longer follow-up (P < .001) presented with increased TCV. In varus cases, the MCV was greater than the LCV (P = .042), with a threshold FAO value of -2.75% or less predicting an increased MCV. In valgus cases, the LCV was greater than the MCV (P = .049), with a FAO threshold value of 4.5% or more predicting an increased LCV.
Conclusion: In this series, the PPC volume after primary TAR significantly correlated with postoperative hindfoot malalignment and longer follow-up.
Level of evidence: Level III, retrospective comparative series.
Keywords: ankle arthroplasty; arthritis; cysts; hindfoot; implant failure; malalignment; total ankle replacement; weightbearing CT.
3D Biometrics for Hindfoot Alignment Using Weightbearing CT.Foot Ankle Int. 2017 Jun;38(6):684-689. doi: 10.1177/1071100717690806. Epub 2017 Feb 9. Foot Ankle Int. 2017. PMID: 28183212
3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography.Foot Ankle Int. 2019 Jun;40(6):720-726. doi: 10.1177/1071100719835492. Epub 2019 Mar 10. Foot Ankle Int. 2019. PMID: 30854889
Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity.Foot Ankle Int. 2020 May 22:1071100720920274. doi: 10.1177/1071100720920274. Online ahead of print. Foot Ankle Int. 2020. PMID: 32441540
Relationship Between Chronic Lateral Ankle Instability and Hindfoot Varus Using Weight-Bearing Cone Beam Computed Tomography.Foot Ankle Int. 2019 Oct;40(10):1175-1181. doi: 10.1177/1071100719858309. Epub 2019 Jun 28. Foot Ankle Int. 2019. PMID: 31253045
Does the subtalar joint compensate for ankle malalignment in end-stage ankle arthritis?Clin Orthop Relat Res. 2015 Jan;473(1):318-25. doi: 10.1007/s11999-014-3960-8. Epub 2014 Oct 15. Clin Orthop Relat Res. 2015. PMID: 25315275 Free PMC article.