Midterm Outcomes of 3-Component Mobile-Bearing Total Ankle Arthroplasty in 124 Ankles: Influence of Preoperative Varus, Valgus, and Neutral Alignment.

Background: The influence of preoperative coronal alignment on outcomes after total ankle arthroplasty (TAA) remains controversial, particularly in the presence of varus or valgus deformity. This study aimed to evaluate midterm clinical and radiographic outcomes of Salto mobile-bearing TAA according to preoperative varus, neutral, and valgus alignment. Methods: This retrospective single-center study reviewed 124 ankles that underwent primary TAA between 2014 and 2021 and were followed up for a minimum of 2 years. Ankles were classified into varus, neutral, and valgus groups based on predefined radiographic criteria. Clinical and radiographic outcomes, as well as implant survivorship, were evaluated. Adjunctive corrective procedures were performed as indicated to address associated deformities. Results: Final clinical outcomes, including American Orthopaedic Foot and Ankle Society scores, visual analog scale pain scores, and ankle range of motion, did not differ significantly among alignment groups. Most radiographic parameters improved postoperatively; however, ankles with preoperative varus alignment demonstrated greater residual hindfoot varus. Kaplan-Meier analysis demonstrated favorable midterm revision-free and reoperation-free survivorship. Conclusions: TAA can achieve favorable midterm clinical outcomes across a spectrum of preoperative coronal alignment patterns when combined with appropriate adjunctive corrective procedures. Varus deformity, including more severe forms, often requires additional correction; however, when appropriately addressed, clinical outcomes are likely to be maintained. Given the limited number of valgus ankles and the midterm follow-up duration, cautious interpretation is warranted, and further studies are needed to clarify long-term outcomes.