Pain-Related Impairment and Talar Tilt as Predictors of Surgical Decision Making in Advanced Varus Ankle Osteoarthritis

Background: Varus-type ankle osteoarthritis (OA) is often managed conservatively; however, surgical intervention is required in some patients. Identifying factors associated with transition to surgery may help optimize treatment timing. Methods: This retrospective study included 53 ankles in 45 patients with Takakura-Tanaka stage ≥3a varus ankle OA who newly initiated conservative treatment with lateral wedge insoles. Patients were classified into nonsurgery or surgery groups based on treatment choice. Multivariate logistic regression was performed using 12 clinical and radiographic variables, including Self-Administered Foot Evaluation Questionnaire (SAFE-Q) subscales and weightbearing radiographic parameters. Results: At baseline, lower pain-related SAFE-Q scores (odds ratio [OR], 0.854; 95% CI, 0.738-0.989; P = .035) and greater talar tilt in the tibial plafond–talar dome angle (TTW) (OR, 1.506; 95% CI, 1.025-2.214; P = .037) were, in multivariable logistic regression, independently associated with surgical selection. The cutoff values for predicting surgery were ≤68 for pain-related SAFE-Q and ≥5° for TTW. With the numbers available, no significant difference could be detected in radiographic parameters at the final assessment. Neither group showed significant longitudinal changes in SAFE-Q or radiographic parameters with the numbers available. Pain-related SAFE-Q scores at the final assessment were significantly better in the nonsurgery than surgery groups. Conclusion: Baseline pain-related impairments and TTW deformities were associated with subsequent surgical selection in patients with advanced varus ankle OA. Level of Evidence: Level III, retrospective comparative cohort study.