Impact of Sagittal Talar Inclination on Total Ankle Replacement Failure
Bibliographic record
Abstract
BACKGROUND: Restoration of ankle alignment is important in total ankle arthroplasty (TAA), but sagittal alignment of the talar component is less studied than coronal sagittal. Little has been published on the importance of sagittal talar alignment in TAA. The radiographic talar component inclination was hypothesized to be predictive of TAA survival, subsidence, and functional outcomes. METHODS: A retrospective review of the Vancouver End-Stage Ankle Arthritis Database was performed on all TAAs at a single center over 11 years utilizing 1 of 2 implants. Talar component inclination (TCI) angles were measured and standard descriptive statistics were completed with a survival analysis. Inter- and intraobserver reliability were determined. Postoperative TCI angles were analyzed against several definitions of TAA survival and patient-reported outcome measures from the database. A total of 109 TAAs satisfied inclusion and exclusion criteria. RESULTS: A postoperative talar component inclination angle greater than 22 degrees was associated with talar component anterior subsidence, defined as a change in that angle of 5 degrees or more between postoperative and last available radiographs. This was still significant after adjusting for confounders: age, gender, body mass index, and presence of inflammatory arthritis. All measured angles had good inter- and intraobserver reliability. CONCLUSION: Surgeons should avoid dorsiflexing the talar prosthesis during TAA, which hypothetically diminishes the ankle critical dorsiflexion range. This may cause anterior talar undercoverage in terminal dorsiflexion and may edge load the talar prosthesis, predisposing to anterior subsidence. Elevated TCI was a simple and reliable radiographic measurement to predict long-term TAA outcome due to predictable anterior subsidence of the talar prosthesis. LEVEL OF EVIDENCE: Level III, retrospective comparative series.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".