Work

Association Between Dynamic Tibiotalar Motion and Patient-Reported Outcomes After Total Ankle Arthroplasty With a Total Talar Prosthesis

Year: 2026

Type: article

Abstract: Background: Although numerous studies have investigated the influence of preoperative deformity and postoperative implant alignment on clinical outcomes after total ankle arthroplasty (TAA), the relationship between dynamic tibiotalar motion and patient-reported outcomes remains unclear. This pilot study investigated whether preoperative, postoperative, and longitudinal changes in computed tomography (CT)-based tibiotalar kinematics are associated with clinical outcomes after combined TAA. Methods: Thirteen ankles that underwent combined TAA for end-stage varus ankle osteoarthritis were retrospectively evaluated. CT was performed preoperatively and 3 months postoperatively with the ankle in active dorsiflexion and plantarflexion under nonweightbearing. Preoperative and postoperative tibial models were registered using a globally optimal iterative closest point algorithm, enabling direct comparison of tibiotalar kinematics within a common tibial coordinate system. Spearman rank correlation was used to assess associations among preoperative kinematics, postoperative kinematics, longitudinal changes, and 2-year postoperative Self-Administered Foot Evaluation Questionnaire (SAFE-Q) scores. Results: All SAFE-Q subscale scores improved significantly ( P < .05 for all) after surgery. Postoperatively, inversion decreased and the rotational pattern between the 2 end positions shifted from external to internal rotation. Postoperative inversion correction, preservation of a physiological internal rotational relationship between the talus and tibia, and plantarflexion-related kinematic parameters showed associations with postoperative SAFE-Q scores. Greater longitudinal correction of plantarflexion inversion and dorsiflexion internal rotation was associated with superior postoperative pain-related outcomes. Conclusion: CT-based tibiotalar kinematics at maximum active dorsiflexion and plantarflexion showed exploratory associations with postoperative patient-reported outcomes after combined TAA. Restoration of postoperative inversion alignment, physiological internal rotational motion, and plantarflexion-related dynamic motion were associated with superior clinical outcomes. Given the small sample size, these findings should be interpreted as hypothesis-generating and require confirmation in larger cohorts. CT-based tibiotalar kinematics assessment using a common tibial coordinate system may provide a basis for further investigation of the relationship between postoperative tibiotalar kinematics and patient-reported outcomes after combined TAA. Level of Evidence: Level III, retrospective cohort study.

Source: Foot & Ankle Orthopaedics

DOI: 10.1177/24730114261496276