Correction of severe valgus osteoarthritis by total knee arthroplasty is associated with increased postoperative ankle symptoms

Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):527-535. doi: 10.1007/s00167-020-06246-4. Epub 2020 Aug 24.


Purpose: The aim of this study was to assess the mid-term clinical outcome of the ankle joint after total knee arthroplasty (TKA) in high-grade valgus osteoarthritis.

Methods: In this case-control study, n = 36 patients with a preoperative mechanical tibiofemoral angle (mTFA) ≥ 15° who underwent TKA between December 2002 and December 2012 were included. The control group (mTFA < 15°) of n = 60 patients was created using case matching. Radiological [mechanical tibiofemoral angle (mTFA) and ankle joint orientation to the ground (G-AJLO)] and clinical parameters [Foot Function Index (FFI), Knee Society Score, Forgotten Joint Score, and Range of Motion (ROM)] were analysed. The mean follow-up time was 59 months (IQR [56, 62]).

Results: The degree of correcting the mTFA by TKA significantly correlated with the postoperative FFI (R = 0.95, p < 0.05), although the knee and ankle joint lines were corrected to neutral orientations. A cut-off value of 16.5° [AUC 0.912 (0.85-0.975 95% CI), sensitivity = 0.8, specificity = 0.895] was calculated, above which the odds ratio (OR) for developing ankle symptoms increased vastly [OR 34.0 (9.10-127.02 95% CI)]. ROM restrictions of the subtalar joint displayed a strong significant correlation with the FFI (R = 0.74, p < 0.05), demonstrating that decreased ROM of the subtalar joint was associated with aggravated outcomes of the ankle joint.

Conclusions: In this study, higher degrees of leg axis correction in TKA were associated with increased postoperative ankle symptoms. When TKA is performed in excessive valgus knee osteoarthritis, surgeons should be aware that this might trigger the onset or progression of ankle symptoms, particularly in cases of a stiff subtalar joint.

Level of evidence: III.

Keywords: Ankle joint; Interplay knee ankle; Osteoarthritis knee; Total knee arthroplasty; Total knee replacement.

MeSH terms

  • Ankle / surgery
  • Ankle Joint / diagnostic imaging
  • Ankle Joint / surgery
  • Arthroplasty, Replacement, Knee* / adverse effects
  • Case-Control Studies
  • Humans
  • Knee Joint / diagnostic imaging
  • Knee Joint / surgery
  • Osteoarthritis, Knee*
  • Range of Motion, Articular
  • Retrospective Studies