Xie K, et al. - Researchers assessed knee malalignment-induced compensatory change in ankle alignment as well as its link with varus knee deformities. They also looked at sex disparities in compensation. Of 103 patients with end-stage knee osteoarthritis who had primary total knee arthroplasty (TKA) from October 2016 to September 2017, 95 knees (78 patients) were included in this study. With the progression of varus knee deformities, an increase in the relative tilt of the talus and distal tibia plafond to the ground was evident. Women demonstrated a positive correlation between the knee alignment and tibial anterior surface angle. They noted that the distal tibia plafond became more valgus as the knee mechanical axis became more varus. A negative correlation between the hip-knee-ankle angle and talar tilt angle (TT) was observed in women. Men did not develop compensatory changes in the ankle alignment and TT to knee alignment. Overall, considering compensatory ankle changes before TKA was recommended based on these findings.