I'm an orthopedic surgeon at Seoul National University Hospital, Korea. I'd like to talk about the relationship between telephebral impingement and increased color tilt in patients with varicose ankle arthritis. The prevalence of ankle arthritis is reported to be about 1% of the world population. Arthroplasty and arthrostasis are the main treatments for, at this stage, ankle arthritis. Medial ankle ovary can be divided into translation type and tilt type. The purpose of this study was to investigate the relationship between telephebral impingement and increased color tilt. This was a retrospective comparative study from May 2015 to April 2019. Bilateral weight-bearing CT and X-rays that were taken of 30 patients with unilateral varicose ankle arthritis, as shown in the photo below. Exclusion criteria are as follows. Varicose arthritis was defined when the color tilt was greater than 4 degrees on weight-bearing plain radiograph. The CT with normal alignment was used as CT. There were 11 males and 19 females, and the average age was 63.8 years. In plain radiograph, the color tilt and distance between the lateral process of the thalus and the tip of the fibula were measured. When the color tilt was more than 10 degrees, it was defined as severe, and less than 10 degrees mild to moderate. In weight-bearing CT, the presence of spur in the fibula tip and thala lateral process was checked in the corner plane, and spur in the thala lateral process was checked and the spur protrusion length was measured in the axial plane. I decided to simulate how much thalofibular hinge occurs. We measure the amount of thalofibular overlap by turning the thalus on the viral side as much as thala tilt on the control side. Two thoracic surgeons measured the radiograph parameter. We can show high internal and intra-observable reliability. Same thing. This is a table comparing the viral side and the control side. The thala tilt was significantly greater with on the viral side than on the control side. On the viral side, the distance between the lateral thala process and the fibula tip was significantly shorter. The protrusion length of the thala spur was also significantly longer. On the viral side, thala spur and fibula spur were observed in almost all cases. According to the simulation, thalofibular overlap was present in all 30 cases of viral side, and thalofibular overlap of 1mm or more was significantly more in the severe thala tilt subgroup, and there were 11 cases of 2mm or more in the severe tilt subgroup. In the study of the arm, distance between thala lateral process and fibula tip was significantly shorter in the thalofibular impingement group. In addition, it has been reported that it is very important to remove the bony impingement. Patients with ankle arthritis tend to develop thala tilt as the arthritis progresses. There are several causes of thala tilt, such as the following. Our results show that thalofibular impingement can prevent maintaining a neutral position and correcting thala tilt in patients with varicose ankle arthritis. However, it is unclear whether thalofibular impingement is a cause or a consequence of varicose arthritis. A limitation of this study is that the simulation of thalofibular overlap is shown in two dimensions, but I think that it has shown overlaps now in the two dimensions. It is difficult to explain the relationship between thalofibular impingement and increased thala tilt from this study. In addition, further studies are needed to determine whether the alignment is actually well maintained when bony impingement are removed. In summary, thalofibular impingement is strongly associated with increased thala tilt in patients with varicose ankle arthritis. Such a thalofibular impingement can be considered as a possible cause that interferes with maintaining a neutral position and preventing the thalofibular impingement from being corrected. Therefore, lateral gluteal osteopathy should be resected to stabilize the mortise and improve the clinical outcome. Thank you for your attention.

telephebral impingement

color tilt

varicose ankle arthritis

thalofibular impingement

clinical outcomes