| Summary: | This study investigated the differences in ankle alignment changes after TKA in patients with varying preexisting ankle deformities. We retrospectively examined 90 knees with osteoarthritis and varus deformity in 78 patients who underwent TKA. Preoperative and postoperative radiographic parameters were analyzed. According to their preexisting ankle deformity, patients were assigned to the valgus or varus group. Overall, 14 (15.6%) cases were of preoperative valgus ankle deformity; the remainder were of preoperative varus ankle deformity. Hip–knee–ankle angle (HKA), tibial plafond–ground angle (PGA), and talus–ground angle (TGA) all exhibited significant correction in both groups; however, tibial plafond–talus angle (PTA) and superior space of ankle joint (SS) only changed in the varus group. The median PTA and SS significantly decreased from 1.2° to 0.3° (<i>p</i> < 0.001) and increased from 2.5 to 2.6 mm (<i>p</i> = 0.013), respectively. Notably, ∆PTA positively correlated with ∆HKA in the varus group (<i>r</i> = 0.247, <i>p</i> = 0.032) but not in the valgus group. Between-group differences in postoperative PTA (<i>p</i> < 0.001) and ∆PTA (<i>p</i> < 0.001) were significant. The degree of ankle alignment correction after TKA differed between patients with preexisting varus and valgus ankle deformities. TKA could not effectively correct the preexisting ankle valgus malalignment.
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