Background: Total ankle arthroplasty (TAA) has grown in popularity and indications, with encouraging results over time. Today, preoperative and postoperative evaluations are mainly performed using clinical test and diagnostic imaging, but there is a deficiency in objectively evaluating the biomechanics of the foot and ankle, which serve as the functional markers for monitoring the effectiveness and outcomes of surgery. Inertial measurement units associated with plantar pressure measurements may provide an accurate and reliable method of evaluating function through the analysis of gait and ankle joint mobility. The aim of this study was to introduce an innovative technology, to assess its accuracy and feasibility compared to standard clinical assessment methods and to objectify kinematic outcomes in patients with end-stage ankle OA before and after TAA surgery. Methods: A consecutive series of eight patients with symptomatic end-stage osteoarthritis and treated with TAA was prospectively evaluated using clinical scores (AOFAS, MOxFQ, VAS, SF-36, 17-IFFI), physical tests (FPI, ALT), plantar pressure measurements with FLEX EPS/R2 Letsense^® baropodometric platform, gait analysis and wearable sensors-based ankle motion and kinematic outcomes using Wiva Science inertial sensors by Letsense^®. Data were collected preoperatively and 4 months after surgery. Results: All PROMs exhibited statistical significance in improvement from pre- to postoperative periods, except for one. Physical examinations showed no significant changes of the foot shape and alignment. Plantar pressure analyses revealed no significant changes in static and dynamic evaluations, but a more uniform distribution of plantar pressure was observed between the two periods. Inertial sensor parameters demonstrated no significant differences, except for a significant reduction in stride length and step length for the operated foot after surgery. Conclusions: Gait analysis using inertial sensors and plantar pressure measurements offer ease of handling, cost effectiveness, portability and swift data reading, making them highly appealing for widespread clinical use. Integrating these tools into the routine assessments of patients with TAA holds promise for advancing precision of treating this condition and our depth of its understanding, contributing to more comprehensive and insightful patient care.

Purpose: This retrospective study aims to compare surgical outcomes between two cohorts of patients who underwent total ankle arthroplasty (TAA) using either standard technique or patient-specific instrumentation (PSI). Methods: A consecutive series of patients who affected of end-staged ankle osteoarthritis were retrospectively assessed and divided into two groups based on TAA techniques: a TAA standard technique group and a TAA-using PSI group. The two groups were compared in terms of operative time, additional procedures, complications (neurovascular and wound problems, infection, loosening and osteolysis, revision and explantation rates, and perioperative fracture), clinical scores, and range of motion (ROM). Result: Fifty-one patients underwent standard TAA, while 13 patients underwent TAA with PSI. At 1-year follow-up, there were no significant differences in complication rates between the two groups (p > 0.05). AOFAS scores were similar, with the standard TAA group scoring 83.33 ± 7.55 and the PSI group scoring 82.92 ± 9.7 (p = 0.870). Likewise, the postoperative ROM did not differ significantly, with 15.12 ± 7.6 degrees for the standard TAA group and 16.05 ± 6.7 degrees for the PSI group (p = 0.689). However, the standard TAA group experienced significantly longer operative time (107.1 ± 22.1 min) compared to the PSI group (91.92 ± 22.9 min, p = 0.032). Additionally, the standard TAA group required more adjunctive procedures (29.7%) compared to the PSI group (7.7%, p = 0.04). Residual pain was also more frequently reported in the standard TAA group (62.7%) than in the PSI group (30.7%, p = 0.038). Conclusion: While both techniques resulted in comparable complication rates, clinical scores and ROM, the PSI group reported significantly shorter operative time and less residual pain, thus requiring fewer postoperative procedures.

Subtalar distraction arthrodesis (SDA) is a surgical procedure designed to treat hindfoot deformities associated with isolated subtalar joint arthritis. In 1996, Fitzgibbons was the first to observe that, in some cases, hindfoot fusion appeared to be associated with the development of tibiotalar valgus tilt. Since then, few studies have addressed this issue. Given that hindfoot fusion can be performed using various techniques, this study investigated the potential tibiotalar joint frontal or sagittal modifications resulting from the modified Grice–Green technique. All the consecutive patients who underwent the modified Grice–Green procedure were included. The patient records were reviewed to extract demographic data. Weight-bearing foot and ankle radiographs were assessed to measure the talar tilt angle and the tibiotalar ratio on the same picture archiving and communication system by three independent observers. A total of 69 patients met the criteria for inclusion. The mean talar tilt showed no substantial changes, since the increase from 1.46 ± 1.62 preoperatively to 1.93 ± 2.19 at a minimum of 8 months postoperatively was not statistically significant (p = 0.47). The average preoperative tibiotalar ratio significantly increased from 33.4 ± 4.4% to 35 ± 4% postoperatively (p = 0.007), although remaining within the normal range, indicating a possible realignment of the posterior facet of the subtalar joint. In conclusion, this study highlights the effectiveness of the modified Grice–Green procedure in achieving a favorable realignment without impacting the ankle joint, particularly regarding tibiotalar valgus tilt.