| Purpose To investigate the changes of ankle joint and posterior foot line after total knee arthroplasty of varus knee,and analyze the relationship between ankle pain and ankle pain.Methods:81 patients with inverted knee osteoarthritis who underwent unilateral TKA were prospectively selected from the Department of Joint surgery of the affiliated Hospital of Qing Dao University from August 2020 to January 2021.The X-ray films of the lower extremity,the axial X-ray of the hindfoot and the lateral X-ray of the ankle joint were taken before and after operation.The ankle pain of all patients was recorded before operation and 6 months after operation.The changes of knee varus,posterior foot line and tibia and heel tibia were measured and compared before and after operation.According to the positive or negative degree of foot line before and after operation,81 patients were divided into two groups:hindfoot valgus group(n=66)and hindfoot valgus group(n=15).According to whether the ankle joint had symptoms before operation,81 patients were divided into two groups:ankle symptomatic group(n=9)and ankle asymptomatic group(n=72).According to the body mass index,81 patients were divided into two groups according to the average body mass index 27.49 kg/m~2.The above average body mass index group was defined as partial weight group and the lower average body mass index group was defined as non-partial weight group.Result:1.Pearson correlation analysis of preoperative knee varus angle,posterior foot force line angle and tibia calcaneal angle:the correlation coefficient between preoperative knee varus angle and preoperative and postoperative foot force line angle is r=0.268(P<0.05),the correlation coefficient between preoperative knee varus angle and preoperative tibial calcaneal angle is r=-0.218(P<0.05),and the correlation coefficient between preoperative and postoperative foot force line angle and preoperative tibial calcaneal angle is r=0.207(P>0.05).2.There was no significant difference in preoperative baseline data between hind foot valgus group and hind foot varus group except for the angle of hind foot force line(P>0.05).The knee varus angle,the force line angle of the back foot and the angle of the tibia and calcaneus of the patients in the back foot valgus group and the back foot varus group decreased after operation,and the difference was statistically significant(P<0.05).There was no significant difference in the average correction angle of genu varus and tibia calcaneus between the two groups before and after operation(P>0.05),and the change of posterior foot force line angle was statistically significant(P<0.05).3.the incidence rate of ankle joint pain was 11.1%before TKA and 13.6%after operation.There was no significant difference in the incidence of ankle pain before and after TKA(P=0.418>0.05).The number of symptomatic patients in the preoperative symptomatic group(n=7),asymptomatic patients in the preoperative symptomatic group(n=2),symptomatic patients in the preoperative asymptomatic group(n=4)and asymptomatic patients in the preoperative asymptomatic group(n=68)were tested by chi square test,andχ2=35.556,P<0.05。There was no significant difference in preoperative age,knee varus angle,tibial calcaneal angle and posterior foot force line angle between symptomatic ankle group and asymptomatic ankle group(P>0.05),but there was significant difference in BMI between symptomatic ankle group and asymptomatic ankle group(P<0.05).The knee varus angle,tibial calcaneal angle and posterior foot force line angle in the asymptomatic ankle group decreased before and after operation,and the difference was statistically significant(P<0.05),while the knee varus angle in the symptomatic ankle group decreased before and after operation,the difference was statistically significant(P<0.05),and the changes of tibial calcaneal angle and posterior foot force line angle were not statistically significant(P>0.05).The average correction angle of genu varus and the change angle of posterior foot force line before and after operation in the two groups were similar,and the difference was not statistically significant(P>0.05);However,the change of tibial calcaneal angle before and after operation in the asymptomatic ankle group was greater than that in the symptomatic ankle group,the difference was statistically significant(P<0.05).4.There was no significant difference in preoperative baseline data between non biased recombination group and biased group(P>0.05).The number of asymptomatic ankle joints(n=40)in the non-weight group,the number of symptomatic ankle joints(n=2)in the non-weight group,the number of asymptomatic ankle joints(n=32)in the weight group and the number of symptomatic ankle joints(n=7)in the weight group were tested by chi square test,andχ2=3.89,P<0.05。The change of knee varus angle before and after unbiased reconstruction was 8.78±4.71,the change of posterior foot force line angle was-0.65±2.20°,and the change of tibial calcaneal angle was-1.48±1.98°;in the overweight group,the change of knee varus angle before and after operation was 9.55±3.91°,the change of posterior foot force line angle was-1.20±2.31°,and the change of tibial calcaneal angle was-1.57±3.61°.The changes of knee varus,posterior foot force line angle and tibial calcaneal angle before and after operation in the nonbiased recombination group and the biased group were similar,and the difference was not statistically significant(P>0.05).Conclusion:1.The incidence rate of ankle pain in OA patients with knee varus before and after TKA had no significant change.2.There is a certain relationship between preoperative ankle symptoms and body mass index.The higher the body mass index,the greater the likelihood of ankle pain.However,there were no significant differences in age,genu varus angle,calcaneus valgus angle,or tibia calcaneus angle.3.For patients with knee varus OA,there is a certain correlation between the preoperative knee varus angle and the posterior foot force line angle,as well as the tibial calcaneal angle:there is a positive correlation between the knee varus angle and the posterior foot force line angle,and a negative correlation with the tibial calcaneal angle.4.After TKA,the knee varus angle,posterior foot force line angle and tibial calcaneal angle changed and tended to decrease. |
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