Joint Line Considerations in TAA

by Vince Vacketta, DPM

The importance of restoring the native joint line has been well studied in TKA. As surgeons continue to work to improve total ankle arthroplasty (TAA) results, new research focuses on the implications of tibiotalar joint height (TTJH)  in its impact on TAA outcomes. 

What goes up, must come down 

Recent studies by both Fletcher et al. and Palma et al. have further confirmed the presence of proximal joint migration in ankle osteoarthritis (OA), like what has been observed in knee OA. These studies have also shown that proximal migration of the TTJH following TAA is associated with decreased range of motion. Importantly, Palma et al. demonstrated that increased TTJH with TAA is correlated with decreased patient PROMIS scores, indicating poorer clinical outcomes. 

This new research provides valuable insights and radiographic parameters that can help surgeons in understanding changes in TTJH and improve patient outcomes in TAA. It also highlights the need for modular tibial base plate design, which would allow surgeons to build and restore TTJH while minimizing tibial bone resection.