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 machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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 source (direct Gemma or distilled Codex), 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".