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Gong X, Yang X, Li X, Guan J, Wang X, Zhang B, Wang Y, Li Y, Sun N, Du H, Lai L, Li W, Li H, Wu Y. Analysis of radiologic parameters and clinical outcomes in supramalleolar osteotomy for varus ankle osteoarthritis: A novel method for evaluating ankle alignment. Foot Ankle Surg 2024:S1268-7731(24)00119-X. [PMID: 38853037 DOI: 10.1016/j.fas.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/13/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Solely relying on the tibial ankle surface (TAS) angle for determining the mechanical ankle axis might be insufficient. We introduce a novel method to determine the distance from the center of the talus to the tibial axis (TTD). This study aimed to investigate the association between clinical outcomes and radiological changes before and after supramalleolar osteotomy (SMO), including TAS angle, talar tilt (TT) angle, tibiotalar surface (TTS) angle and TTD. METHODS Seventy patients who received SMO were enrolled. Radiological changes were measured using weight-bearing anteroposterior imaging. The percentage of talar center displacement (TTDP) was calculated as the difference between postoperative and preoperative TTD, divided by talar width (TW). Clinical assessments were performed using the American Orthopedic Foot and Ankle Society ankle-hindfoot (AOFAS) scale. Differences in the aforementioned indicators before and after the operation were analyzed. We defined ΔAOFAS, ΔTAS, ΔTT and ΔTTS as the difference between postoperative and preoperative values. RESULTS ΔTTS correlated with ΔAOFAS (r = 0.40, p = 0.008), as did TTDP (r = 0.32, p = 0.035). No correlation was observed between ΔAOFAS and ΔTAS. In the comparison between groups, patients with a TTDP greater than 26.19 exhibited a significantly greater ΔAOFAS. The high intraclass correlation coefficient indicated good reliability of the novel method. CONCLUSION Solely relying on the TAS angle for tibial correction was insufficient. We found TTD as a novel method to evaluate mechanical ankle joint axis. TTDP and ΔTTS both positively correlated with ΔAOFAS, indicating the usefulness of these radiologic parameters.
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Affiliation(s)
- Xiaofeng Gong
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Xiaosong Yang
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Xing Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Jack Guan
- Bay Area Foot and Ankle Medical Clinic, San Jose 3150, CA, USA
| | - Xuewen Wang
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Baozhou Zhang
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Yan Wang
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Ying Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Ning Sun
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Hui Du
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Liangpeng Lai
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Wenjing Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Heng Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Yong Wu
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China.
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Jie K, Liang J, Xu J, Zou Y, Li B, Tan Y, Zhang H, Zhu Y. Changes in clinical outcomes and alignment of the ipsilateral knee and ankle after supramalleolar osteotomy in patients with varus osteoarthritis of the ankle: a short-term follow-up study. Arch Orthop Trauma Surg 2024; 144:161-170. [PMID: 37789151 DOI: 10.1007/s00402-023-05079-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/17/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE The purpose of this study was to investigate the changes in clinical outcomes and alignment of the ipsilateral knee and ankle in patients with varus ankle osteoarthritis after supramalleolar osteotomy (SMO). METHODS We retrospectively reviewed 23 patients (24 ankles) with Takakura II, IIIa and IIIb ankle osteoarthritis treated with SMO between May 2017 and March 2022. The radiologic parameters of ankles contained medial distal tibial angle (TAS), tibiotalar angle (TT), tibial lateral surface (TLS), tibial plafond inclination (TPI) and talar inclination (TI). The radiologic parameters of knees contained medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), the knee joint line orientation relative to ground (G-KJLO) and WBL. Hip-knee-ankle angle (HKA) was also collected. The Takakura system was used for evaluating the ankle osteoarthritis and the Kellgren-Lawrence (KL) system was used for evaluating the knee osteoarthritis. Clinical evaluation of the ankle joints contained American Orthopedic Foot and Ankle Society (AOFAS), range of motion (ROM) and visual analogue scale (VAS). Clinical evaluation of the knee joints contained Japanese Orthopaedic Association Scores (JOA), ROM, VAS. RESULTS The mean follow-up times were 20.3 ± 7.3 months (range 12-38). According to the radiologic evaluation, the TAS increased from preoperative 84.7° ± 2.0° to 91.2° ± 1.8° at the last follow-up (P < 0.001). The TPI and TI decreased from 4.4° ± 4.2° and 11.0° ± 5.2° to 0.1° ± 4.7° and 4.1° ± 4.8° (P < 0.001 for both). The TT angel improved from 9.5° ± 4.1° to 4.9° ± 3.3° (P < 0.001). No significant differences were found regarding MPTA, JLCA, G-KJLO, knee WBL and HKA (P > 0.05 for all). The Takakura stage improved after SMO (P < 0.001) whilst the KL stage maintains the similar lever (P > 0.05). According to the clinical evaluation, the AOFAS significantly increased from 67.5 ± 10.6 to 88.5 ± 9.3 and the VAS of the ankle decreased from 4.7 ± 1.6 to 1.2 ± 1.1, whilst there were no changes on VAS and even the JOA and knee ROM after SMO (P > 0.05 for all). CONCLUSIONS SMO can alleviate the symptoms of varus ankle osteoarthritis and delay the time for ankle replacement or arthrodesis by redistributing the abnormal stress of the ankle and restoring the congruence of the tibiotalar joint. In addition, it did not induce the clinical symptoms of knee without compromising lower limb alignment or knee joint line orientation in the short term. LEVEL OF EVIDENCE Level IV case series.
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Affiliation(s)
- Ke Jie
- Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China
| | - Jinjie Liang
- Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China
| | - Jingcheng Xu
- Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China
| | - Yunxuan Zou
- Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China
| | - Biyi Li
- Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China
| | - Yanqing Tan
- Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China
| | - Hongning Zhang
- Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China
| | - Yongzhan Zhu
- Foshan Hospital of Traditional Chinese Medicine, 6 Qinren Road, Foshan, 528000, Guangdong, China.
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Zhang S, Sun C, Zhang J, Wang Z, Zhao H, Zhang M. Changes in the subtalar joint alignment after supramalleolar osteotomy for varus ankle arthritis. Foot Ankle Surg 2023; 29:475-480. [PMID: 37407354 DOI: 10.1016/j.fas.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/11/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The subtalar joint may compensate for tibio-talar deformity, but what would happen to the joint after the deformity was corrected is not well known. Supramalleolar osteotomy (SMOT) is an effective procedure for the treatment of varus deformity of ankle arthritis. The objective of this study was to investigate the subtalar joint alignment pre and postoperatively following SMOT, and the factors which influenced the alignment of the subtalar joint. METHODS Thirty-one patients with varus ankle arthritis (Takakura stage 2, 3a and 3b) who were treated using SMOT were retrospectively reviewed. The subtalar and ankle joint alignment was measured on weightbearing radiograph and weightbearing computerized tomography (WBCT). RESULTS The foot and ankle offset (FAO), tibial articular surface angle (TAS), tibio-talar surface angle (TTS), and subtalar vertical angle (SVA) were significantly corrected (P<0.05). The subtalar inclination angle (SIA) decreased in 19 patients and increased in the other 12 cases after the SMOT (P<0.001). The shift of subtalar joint (ΔSIA) showed an inverse correlation with the preoperative FAO (P<0.001, r = -0.621). CONCLUSIONS The shift of subtalar joint after SMOT could maintain the neutral position of the hindfoot and showed a negative correlation with the preoperative FAO. The ΔSIA was greater in the severer preoperative hindfoot deformity. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Shu Zhang
- Department of Foot and Ankle Surgery , Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Chao Sun
- Department of Foot and Ankle Surgery , Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jianzhong Zhang
- Department of Foot and Ankle Surgery , Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Zhi Wang
- Department of Foot and Ankle Surgery , Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Hongmou Zhao
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China.
| | - Mingzhu Zhang
- Department of Foot and Ankle Surgery , Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
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Beijk I, Burgerhof J, de Vries AJ, van Raaij TM. Is there an optimal degree of correction for ankle varus deformity after supramalleolar osteotomy? A systematic review. Foot Ankle Surg 2022; 28:1139-1149. [PMID: 35738984 DOI: 10.1016/j.fas.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no consensus on the angle targeted for in varus ankle deformity after supramalleolar osteotomy (SMOT). The aim of this study was to investigate which obtained correction has the best clinical outcome after valgus SMOT. METHODS A systematic review according PRISMA guidelines was conducted with studies being eligible for inclusion when published in English, German or Dutch, patients older than 18 years at study entrance, primary or posttraumatic varus ankle osteoarthritis, using any valgus SMOT technique, describing radiological alignment and clinical outcome at baseline and after at least 12 months follow-up. Risk of bias was assessed using the McMaster University Occupational Therapy Evidence-Based Practice Research Group quality assessment tool. The electronical databases PubMed, EMBASE and Cinahl were used as data sources. Included cohorts were categorized according to the mean obtained medial distal tibia angle (MDTA; ranged between 87° and 100°). A linear mixed effect model was used for individual patient data to assess the association between the MDTA and the (difference in) clinical outcome. RESULTS Thirty studies including 33 patient cohorts with 922 ankles were identified. At a mean follow-up of 4 years no differences in clinical outcome between correction categories were found. Individual data of 34 ankles showed no relationship between obtained MDTA and clinical outcome either. CONCLUSION This review could not demonstrate an optimal degree of correction after valgus SMOT. Results were hampered by biased low quality studies and the widespread use of unreliable 2D alignment measures such as the MDTA.
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Affiliation(s)
- Iris Beijk
- Department of Orthopedic Surgery, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, the Netherlands
| | - Johannes Burgerhof
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Astrid J de Vries
- Department of Orthopedic Surgery, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, the Netherlands
| | - Tom M van Raaij
- Department of Orthopedic Surgery, Martini Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, the Netherlands.
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Yang XQ, Zhang Y, Wang Q, Liang JQ, Liu L, Liang XJ, Zhao HM. Supramalleolar Osteotomy vs Arthrodesis for the Treatment of Takakura 3B Ankle Osteoarthritis. Foot Ankle Int 2022; 43:1185-1193. [PMID: 35658553 DOI: 10.1177/10711007221099183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To compare the clinical/functional outcomes of supramalleolar osteotomy (SMOT) and ankle arthrodesis (AA) for the treatment of modified Takakura stage 3B ankle osteoarthritis. METHODS Outcomes of 28 SMOT patients and 30 AA patients were reviewed at an average of 50 and 51 months, respectively. The baseline characteristics of the 2 groups were similar. The preoperative tibial articular surface angle and talar tilt angle in the SMOT group were 82.6 and 10 degrees and in the AA group, 83.9 and 9.1 degrees, respectively. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS) score, 12-item Short-Form Health Survey (SF-12) mental component summary (MCS) and physical component summary (PCS) scores, range of motion (ROM), radiologic parameters, and complications were compared. RESULTS The AOFAS, VAS, and SF-12 MCS and PCS scores improved significantly postoperatively in both groups (P < .001). The VAS and SF-12 PCS scores indicate marginally better improvement in the AA group (P < .05). The patient satisfaction value (P = .028) and the possibility of repeated surgery value (P = .012) were also significantly higher in the AA group. The early (P = .905) and late (P = .181) complications did not significantly differ between the 2 groups. The reoperation rate was significantly higher in the SMOT group (P = .038). CONCLUSION Both SMOT and AA showed improvements in function, pain, alignment, and quality of life after surgery. Patients in the AA group reported better pain relief, had a lower reoperation rate, and better hindfoot alignment during a short- to mid-term follow-up time. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Xin-Quan Yang
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Xi'an Medical University, Xi'an, China
| | - Yan Zhang
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qiong Wang
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jing-Qi Liang
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Liang Liu
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiao-Jun Liang
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hong-Mou Zhao
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Xue W, Chen T, Wahafu P, Li F, Xiahatai A, Wufuer A, Tuo Y, Zhao B, Wang C. Efficacy evaluation and systematic review of supramalleolar osteotomy for treatment of varus-type ankle arthritis. J Orthop Surg (Hong Kong) 2022; 30:10225536221122286. [PMID: 35998358 DOI: 10.1177/10225536221122286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The current surgical treatment plan for medium-term varus-type ankle arthritis is primarily supramalleolar osteotomy (SMOT), but the reliability of this procedure still lacks high-quality evidence-based medical studies, such as randomized controlled clinical trials and meta-analyses of comparative studies. OBJECTIVE The current study explored whether significant differences were present in the clinical effect, reoperation rate, complications, and failure rate of this type of surgery. METHOD Two researchers searched the relevant literature in seven databases, including PubMed, Cochrane Library, EMBASE, the China Biomedical Literature Database, the China Academic Journals Full-text Database, the Wanfang database, and the Weipu Chinese Science and Technology Journal Database. The retrieval time spanned the establishment of the specific database up to September 2020, and the literature was screened to determine their final inclusion in the study. RESULTS AND CONCLUSIONS A total of 20 studies were included, including one Chinese and 19 English language studies. The primary indicators included a definitive effect of SMOT on the treatment of medium-term varus-type ankle arthritis. Concerning secondary indicators, although the surgery effect was satisfactory, some patients may require follow-up surgery, which may be unsuccessful with complications. The study results showed that, based on existing literature reports, the effect of SMOT for varus-type ankle arthritis was a satisfactory surgical method with some clinical value for correcting the ankle force line and relieving or even reversing ankle arthritis. However, its risk of complications and failure rate were comparatively high and, accordingly, requires good preoperative planning and close communication with patients. Due to the limited sample size of this study, more data and longer follow-up times involving this type of surgery should be reviewed to confirm this conclusion.
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Affiliation(s)
- Wang Xue
- Department of Orthopedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, China
| | - Tiannan Chen
- Department Burn Surgery, People's Hospital, Yueqing County, Wenzhou, China
| | - Paerhati Wahafu
- Department of Orthopedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, China
| | - Fei Li
- Department of Orthopedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, China
| | - Ayiding Xiahatai
- Department of Orthopedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, China
| | - Aikeremu Wufuer
- Department of Orthopedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, China
| | - Yanan Tuo
- Department of Orthopedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, China
| | - Bo Zhao
- Department of Orthopedic Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, China
| | - Chengwei Wang
- The Third Affiliated Hospital of Xinjiang Medical University, China
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Hintermann B, Ruiz R. Joint Preservation Strategies for Managing Varus Ankle Deformities. Foot Ankle Clin 2022; 27:37-56. [PMID: 35219368 DOI: 10.1016/j.fcl.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Joint preserving strategies have evolved to a successful treatment option in early and midstage medial ankle OA caused by varus deformity. Though talar tilt can often not be fully corrected, it provides substantial postoperative pain relief, functional improvement, and slowing of the degenerative process. Osseous balancing with osteotomies is the main step for restoration of ankle mechanics and normalization of joint load. Overall, the key for success is to understand the underlying causes that have contributed to the varus OA in each case, and to use all treatment modalities necessary to restore appropriate alignment of the hindfoot complex.
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Affiliation(s)
- Beat Hintermann
- Center of Excellence for Foot and Ankle Surgery, Clinic of Orthopaedics and Traumatology, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland.
| | - Roxa Ruiz
- Center of Excellence for Foot and Ankle Surgery, Clinic of Orthopaedics and Traumatology, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland
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Liang JQ, Wang JH, Zhang Y, Wen XD, Liu PL, Liang XJ, Lu J, Li Y, Zhao HM. Fibular osteotomy is helpful for talar reduction in the treatment of varus ankle osteoarthritis with supramalleolar osteotomy. J Orthop Surg Res 2021; 16:575. [PMID: 34565431 PMCID: PMC8474821 DOI: 10.1186/s13018-021-02732-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/16/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There have been debates on the necessity of fibular osteotomy (FO) in supramalleolar osteotomy (SMOT) for the treatment of varus ankle osteoarthritis. The purpose of the current study was to compare the clinical and radiological outcomes between SMOT with and without FO in the treatment of varus ankle osteoarthritis. METHODS The SMOT group included 39 patients, and the SMOT with FO group included 24 patients. The basic information reached no significant difference between groups. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS), modified Takakura stage and range of motion (ROM) were used for the functional evaluation. The radiologic parameters were assessed at the last follow-up to compare the degree of talar reduction between the two groups. RESULTS Both groups achieved significant improvements in AOFAS scores, modified Takakura stage, as well as AOS pain and functional scores (P < 0.001). The ROM of the ankle joint in the SMOT group was significantly decreased (P = 0.022). In both groups, all of the radiological parameters were significantly improved (P < 0.01). The tibiofibular clear space (TFCS) was significantly widened in the SMOT group (P < 0.001). No significant difference was found between the two groups according to the functional outcomes. However, the talar tilt angle (TT) and hindfoot alignment angle (HFA) in the SMOT with FO group were significantly smaller than those in the SMOT group (P < 0.05). The TFCS was significantly widened in the SMOT group (P = 0.001). The medial displacement of the talus (MDT) was better reduced in the SMOT with FO group (P = 0.006). CONCLUSION SMOT is a promising procedure for functional improvement and malalignment correction in varus ankle osteoarthritis but reduces ankle range of motion. If SMOT is combined with FO, talar tilt and medial displacement will be better reduced.
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Affiliation(s)
- Jing-Qi Liang
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, People's Republic of China
| | - Jun-Hu Wang
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, People's Republic of China
| | - Yan Zhang
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, People's Republic of China
| | - Xiao-Dong Wen
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, People's Republic of China
| | - Pei-Long Liu
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, People's Republic of China
| | - Xiao-Jun Liang
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, People's Republic of China
| | - Jun Lu
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, People's Republic of China
| | - Yi Li
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, People's Republic of China
| | - Hong-Mou Zhao
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, People's Republic of China.
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Tacktill J, Rasor Z, Savasky B, Zelen CM. Consideration for Total Ankle Replacement in the Varus Ankle and Cavovarus Foot Type. Clin Podiatr Med Surg 2021; 38:497-504. [PMID: 34053657 DOI: 10.1016/j.cpm.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The varus ankle and cavus foot pose challenges in surgical correction with regard to total ankle replacement surgery. Etiology of cavus foot type and varus ankle must be evaluated and confirmed. Pes cavus is increased height of the arch with metatarsus adductus and increased calcaneal inclination angle. There often is intrinsic musculature irregularity leading to imbalance of the foot. Although not all cavus foot types and varus ankle deformities are sequelae of neuromuscular disorder, neurologic etiology must be considered. Attaining neutral alignment of ankle joint articular surface is paramount to longevity and functionality of ankle joint replacement implant.
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Affiliation(s)
- Jordan Tacktill
- Kaiser Permanente Midatlantic, Washington Hospital Center Residency, 1221 Mercantile Ln, Upper Marlboro, MD 20774, USA; Professional Education and Research Institute, 222 Walnut Avenue, Roanoke, VA 24016, USA
| | - Zachary Rasor
- Professional Education and Research Institute, 222 Walnut Avenue, Roanoke, VA 24016, USA
| | - Benjamin Savasky
- Professional Education and Research Institute, 222 Walnut Avenue, Roanoke, VA 24016, USA
| | - Charles M Zelen
- Professional Education and Research Institute, 222 Walnut Avenue, Roanoke, VA 24016, USA.
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Abstract
Undiagnosed medial ankle instability can be a prerequisite for pathogenic progression in the foot, particularly for adult acquired flatfoot deformity. With the complex anatomy in this region, and the limitations of each individual investigational method, accurately identifying peritalar instability remains a serious challenge to clinicians. Performing a thorough clinical examination aided by evaluation with advanced imaging can improve the threshold of detection for this condition and allow early proper treatment to prevent further manifestations of the instability.
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Affiliation(s)
- Yantarat Sripanich
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok 10400, Thailand
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Martinistr. 52, Hamburg 20246, Germany.
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Shibuya N, McAlister JE, Prissel MA, Piraino JA, Joseph RM, Theodoulou MH, Jupiter DC. Consensus Statement of the American College of Foot and Ankle Surgeons: Diagnosis and Treatment of Ankle Arthritis. J Foot Ankle Surg 2021; 59:1019-1031. [PMID: 32778440 DOI: 10.1053/j.jfas.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/20/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Naohiro Shibuya
- Professor, College of Medicine, Texas A&M University, Temple, TX.
| | | | - Mark A Prissel
- Faculty, Advanced Foot and Ankle Reconstruction Fellowship Program, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Jason A Piraino
- Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, University of Florida Health, Gainesville, FL
| | - Robert M Joseph
- Chairman, Department of Podiatric Medicine & Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL
| | - Michael H Theodoulou
- Chief, Division of Podiatric Surgery, Cambridge Health Alliance, Instructor of Surgery, Harvard Medical School, Cambridge, MA
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX
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12
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Chilmi MZ, Desnantyo AT, Widhiyanto L, Wirashada BC. Low Tibial and Fibular Osteotomy for Treating Varus-Type Post-Traumatic Ankle Osteoarthritis: A Case Report. Malays Orthop J 2020; 14:145-148. [PMID: 32983392 PMCID: PMC7513647 DOI: 10.5704/moj.2007.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In Indonesia, arthrodesis becomes a choice of treatment in the absence of ankle arthroplasty implants for young adults. Arthrodesis on ankle osteoarthritis (OA) often leads to functional impairment. Low tibiofibular osteotomy is an alternative and it has been known to be the preferable option for those in the productive-ages. A 22-year-old male with a previous history of a motorbike accident, operated eight years ago, came with persistent pain on the left ankle that has worsened over the years. Plain radiography with a tibial-ankle surface angle (TAS) of 74o (normally 88o-93o) indicated varus deformity. Osteotomy was performed on distal tibia above the syndesmotic joint, as well as on the middle third of fibula. Open wedge osteotomy of the tibia was corrected until the normal TAS angle was reached by fluoroscopy. Cortical allograft was used to fill the osteotomy gap. Instrumentation was performed using a clover leaf® plate with 6 screws insertion for fixation stability. All results were satisfactory. Twelve weeks post-operatively, the patient was performing activities normally. Four-month post-operative radiological evaluation showed fusion of graft and the angle of TAS of 89°. Post-operative functional assessment using the American Academy of Orthopaedic Surgeon (AAOS) Foot and Ankle Measurement (FAM) questionnaires showed significant improvement (pre 89, post 38).
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Affiliation(s)
- M Z Chilmi
- Department of Orthopaedic and Traumatology, Universitas Airlangga, Surabaya, Indonesia
| | - A T Desnantyo
- Department of Orthopaedic and Traumatology, Universitas Airlangga, Surabaya, Indonesia
| | - L Widhiyanto
- Department of Orthopaedic and Traumatology, Universitas Airlangga, Surabaya, Indonesia
| | - B C Wirashada
- Department of Orthopaedic and Traumatology, Universitas Airlangga, Surabaya, Indonesia
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13
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Abstract
In the last few years, much has been published concerning total joint arthroplasty, and debates and discussions to new questions and points of view started many years ago. In this commentary, we report the latest evidence of best practice in the field of lower limb arthroplasty; this evidence is based on a literature search conducted by using PubMed and Scopus databases with a time limit of five years. We found novel evidence regarding cemented and not cemented implant, implant design, anticoagulant use, tourniquets, and other aspects of joints replacement surgery that we consider a common part of modern orthopedic practice. We specifically focus on lower limb joint replacement.
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Affiliation(s)
- Rocco Aicale
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Diovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Diovanni di Dio e Ruggi D'Aragona, Salerno, Italy.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, UK.,School of Pharmacy and Bioengineering, Faculty of Medicine, Institute of Science and Technology in Medicine, Guy Hilton Research Centre, Keele University, Stoke-on-Trent, UK
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15
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Ankle morphometry based on computerized tomography. Foot Ankle Surg 2019; 25:674-678. [PMID: 30306892 DOI: 10.1016/j.fas.2018.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/02/2018] [Accepted: 08/01/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Thorough understanding of the morphometry of the ankle joint is crucial to optimize conservative and operative therapy of ankle joint disorders. Despite recent improvements, basic anatomic and biomechanical correlations of the ankle joint including the orientation of the ankle joint axis and joint morphology as its key biomechanical features are not sufficiently recorded to date. The aim of this study was the evaluation of the ankle morphometry to gain information about the ankle joint axis. MATERIAL AND METHODS In this study 98 high-resolution CT-scans of complete Caucasian cadaver legs were analysed. Using the software Mimics and 3-Matic (Materialize) 22 anatomic parameters of the talocrural joint were assessed, including the length, width and surface area of the tibial and talar articular areas. Additionally, the radii of the articular areas, the medial distal tibial angle and the height of the talar dome were determined. RESULTS The radius of the central trochlea tali was 44.6±4.1mm (mean±SD). The central trochlea tali arc length was 40.8±3.0mm and its width was 27.4±2.5mm. Additionally we determined 47.0±4.4mm for the tibial sagittal radius, 27.6±3.0mm for the tibial arc length and 27.4±2.5mm for the central tibial width. CONCLUSION The present study describes the three-dimensional morphometry of Caucasian ankle joints in detail. This dimensional analysis of the ankle joint will inform the development and placements of implants and prostheses.
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16
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Johnson-Lynn S, Siddique M. The Effect of Sagittal and Coronal Balance on Patient-Reported Outcomes Following Mobile-Bearing Total Ankle Replacement. J Foot Ankle Surg 2019; 58:663-668. [PMID: 30962111 DOI: 10.1053/j.jfas.2018.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Indexed: 02/03/2023]
Abstract
Total ankle replacement (TAR) is an established technique for the treatment of end-stage ankle arthritis. The aims of TAR include pain relief, preservation of tibiotalar movement, protection of adjacent joints, and restoration of anatomic alignment in the coronal and sagittal planes. The aims of this study were to determine the relative importance of pre- and post-TAR coronal and sagittal balance on postoperative patient-reported outcome measures (PROMs). A total of 101 ankles in 99 patients were included in this retrospective cohort study. Patients were scored preoperatively and at a minimum of 2 years by using the Foot and Ankle Outcome Score (FAOS), the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot-ankle score, the Short Form-36 measures, and a set of radiographic measurements to define the sagittal and coronal alignment. There was no significant difference between the groups regarding the anterior or posterior translation of the talus preoperatively. There were no statistically significant correlations between any preoperative measure and any domain of the PROM data. Significant correlations were observed between postoperative medial distal tibial angle and the function domain of the FAOS and the AOFAS hindfoot-ankle score. Preoperative coronal and sagittal plane deformity are not markedly different, depending on the diagnosis. Preoperative deformity does not appear to correlate significantly with postoperative function, as measured by the PROM scores. Postoperative sagittal plane alignment does not correlate significantly with postoperative function, as measured by PROMs. Coronal plane alignment, as measured by the medial distal tibial angle, may be associated with postoperative function, as measured on the AOFAS hindfoot-ankle and FAOS function subscales.
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Affiliation(s)
- Sarah Johnson-Lynn
- Orthopaedic Registrar, Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne, UK.
| | - Malik Siddique
- Consultant Orthopaedic Surgeon, Department of Orthopaedics, Freeman Hopsital, Newcastle upon Tyne, UK
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17
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Scheidegger P, Horn Lang T, Schweizer C, Zwicky L, Hintermann B. A flexion osteotomy for correction of a distal tibial recurvatum deformity. Bone Joint J 2019; 101-B:682-690. [DOI: 10.1302/0301-620x.101b6.bjj-2018-0932.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aims There is little information about how to manage patients with a recurvatum deformity of the distal tibia and osteoarthritis (OA) of the ankle. The aim of this study was to evaluate the functional and radiological outcome of addressing this deformity using a flexion osteotomy and to assess the progression of OA after this procedure. Patients and Methods A total of 39 patients (12 women, 27 men; mean age 47 years (28 to 72)) with a distal tibial recurvatum deformity were treated with a flexion osteotomy, between 2010 and 2015. Nine patients (23%) subsequently required conversion to either a total ankle arthroplasty (seven) or an arthrodesis (two) after a mean of 21 months (9 to 36). A total of 30 patients (77%), with a mean follow-up of 30 months (24 to 76), remained for further evaluation. Functional outcome, sagittal ankle joint OA using a modified Kellgren and Lawrence Score, tibial lateral surface (TLS) angle, and talar offset ratio (TOR) were evaluated on pre- and postoperative weight-bearing radiographs. Results Postoperatively, the mean score for pain, using a visual analogue scale, decreased significantly from 4.3 to 2.5 points and the mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly from 59 to 75 points (both p < 0.001). The mean TLS angle increased significantly by 6.6°; the mean TOR decreased significantly by 0.24 (p < 0.001). Radiological evaluation showed an improvement or no progression of sagittal ankle joint OA in 32 ankles (82%), while seven ankles (18%) showed further progression. Conclusion A flexion osteotomy effectively improved the congruency of the ankle joint. In 30 patients (77%), the joint could be saved, whereas in nine patients (23%), the treatment delayed a joint-sacrificing procedure. Cite this article: Bone Joint J 2019;101-B:682–690.
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Affiliation(s)
- P. Scheidegger
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - T. Horn Lang
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - C. Schweizer
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - L. Zwicky
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - B. Hintermann
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
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18
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Zhao HM, Wen XD, Zhang Y, Liang JQ, Liu PL, Li Y, Lu J, Liang XJ. Supramalleolar osteotomy with medial distraction arthroplasty for ankle osteoarthritis with talar tilt. J Orthop Surg Res 2019; 14:120. [PMID: 31060592 PMCID: PMC6501463 DOI: 10.1186/s13018-019-1168-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/26/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND An increased preoperative talar tilt (TT) angle was reported to be positively correlated with treatment failure after supramalleolar osteotomy (SMOT) for varus ankle osteoarthritis. Distraction arthroplasty was reported to have the ability to correct increased TT angles. The purpose of the current study was to compare the outcomes between SMOT with and without medial distraction arthroplasty (MDA) in the treatment of varus ankle osteoarthritis with increased TT angles. METHODS We retrospectively reviewed the functional outcomes and radiological findings of 34 patients who underwent SMOT with or without MDA for varus ankle osteoarthritis with increased TT angles. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Ankle Osteoarthritis Scale (AOS) scores were used for functional evaluation. The tibial anterior surface (TAS) angle, talar tilt (TT) angle, tibial medial malleolar (TMM) angle, talocrural (TC) angle, tibial lateral surface (TLS) angle, and hindfoot alignment (HFA) angle were evaluated preoperatively and at the time of the last follow-up. RESULTS In the SMOT group, the AOFAS score and AOS pain and function scores were significantly improved (P < 0.01 for each) at a mean follow-up of 61 months. The TAS, TT, TC, TLS, and HFA angles were all significantly improved (P < 0.01 for each). Similarly, in the SMOT with MDA group, the AOFAS score, AOS pain and function scores, and the TAS, TT, TC, TLS, and HFA angles were all significantly improved postoperatively (P < 0.01 for each). When comparing the two groups, the postoperative TT angle was significantly smaller in the SMOT with MDA group (P = 0.023) than in the SMOT group. In addition, the failure rate of TT angle correction was significantly higher in the SMOT group (P = 0.016) than in the SMOT with MDA group. CONCLUSION SMOT is a promising procedure for functional improvement and malalignment correction for varus ankle osteoarthritis, even in patients with increased talar tilt. If SMOT is combined with MDA, there can be an improvement in the correction of the increased talar tilt. LEVEL OF EVIDENCE Level III, a retrospective comparative study.
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Affiliation(s)
- Hong-Mou Zhao
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, 710054, China
| | - Xiao-Dong Wen
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, 710054, China
| | - Yan Zhang
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, 710054, China
| | - Jing-Qi Liang
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, 710054, China
| | - Pei-Long Liu
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, 710054, China
| | - Yi Li
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, 710054, China
| | - Jun Lu
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, 710054, China
| | - Xiao-Jun Liang
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, 710054, China.
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19
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Usuelli FG, Di Silvestri CA, D’Ambrosi R, Orenti A, Randelli F. Total ankle replacement: is pre-operative varus deformity a predictor of poor survival rate and clinical and radiological outcomes? INTERNATIONAL ORTHOPAEDICS 2018; 43:243-249. [DOI: 10.1007/s00264-018-4189-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 09/26/2018] [Indexed: 12/14/2022]
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20
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Sun Z, Li N, Zhang T, Xin J, Ma X. [Progress of total ankle arthroplasty for end-stage ankle osteoarthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1313-1316. [PMID: 30215493 DOI: 10.7507/1002-1892.201803028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the progress of total ankle arthroplasty (TAA) in treatment of end-stage ankle osteoarthritis (AOA). Methods The domestic and foreign literatures about TAA in recent years were reviewed. The current status and progress of TAA were summarized from the results of traditional and computer-assisted TAA clinical outcomes. Results End-stage AOA often leads to severe pain and dysfunction, and arthrodesis is still the main selective treatment option. In recent years, with the advancement of surgical techniques and prosthesis design, TAA which can remain joint mobility has increased gradually, and the surgical results also have significant progress. Accurate prosthesis implant and mechanical alignment restoration are critical factors for TAA, and surgery-related malalignment is correlative to the prosthesis failure. Computer assisted patient-specific guide can simplify the TAA procedures and obtain the accuracy of tibia and talus osteotomy. Conclusion The clinical efficiency of preoperative CT based patient-specific guide technology for TAA needs further clinical follow-up. Meanwhile, it is necessary to further develop intraoperative navigation and robotic surgery system suitable for TAA.
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Affiliation(s)
- Zhenhui Sun
- Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China[]
| | - Nan Li
- Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China[]
| | - Tao Zhang
- Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China[]
| | - Jingyi Xin
- Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China[]
| | - Xinlong Ma
- Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China[]
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Zhao HM, Liang XJ, Li Y, Ning N, Lu J. Supramalleolar Osteotomy With Distraction Arthroplasty in Treatment of Varus Ankle Osteoarthritis With Large Talar Tilt Angle: A Case Report and Literature Review. J Foot Ankle Surg 2018; 56:1125-1128. [PMID: 28558996 DOI: 10.1053/j.jfas.2017.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Indexed: 02/03/2023]
Abstract
We treated a 57-year-old female with modified Takakura stage 3B varus ankle osteoarthritis. Her preoperative talar tilt angle was 21.3°. The patient wished to avoid ankle joint arthrodesis or replacement. Therefore, medial opening wedge supramalleolar osteotomy with fibular osteotomy was used for her varus ankle osteoarthritis. Also, fixed medial distraction arthroplasty was performed to improve her talar tilt. After 3 months, the external device was removed, and the patient was allowed partial weightbearing and began full weightbearing 4 months postoperatively after the osteotomy site had reached bony union radiographically. At the 3-year follow-up visit, a radiograph showed the medial ankle joint space enlargement had been maintained. The talar tilt angle had decreased to 3.3°, and the modified Takakura stage had improved to stage 1. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale score had improved from 26 points preoperatively to 85 points at 3 years postoperatively. Our findings suggested that good clinical and radiologic results can be achieved with supramalleolar osteotomy combined with distraction arthroplasty in the treatment of varus ankle osteoarthritis with a large talar tilt angle.
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Affiliation(s)
- Hong-Mou Zhao
- Orthopedist, Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Xiao-Jun Liang
- Professor and Chief, Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China.
| | - Yi Li
- Assistant Professor, Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Ning Ning
- Orthopedist, Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Jun Lu
- Assistant Professor, Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
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Hintermann B, Zwicky L, Schweizer C, Ruiz R, Barg A. The Use of Supramalleolar Osteotomies in Posttraumatic Deformity and Arthritis of the Ankle. JBJS Essent Surg Tech 2017; 7:e29. [PMID: 30233964 DOI: 10.2106/jbjs.st.16.00081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Osteoarthritis of the ankle is a debilitating musculoskeletal disease that affects approximately 1% of adults worldwide. The most common etiology of ankle osteoarthritis is trauma. In general, patients with ankle osteoarthritis are 12 to 15 years younger than patients with hip or knee osteoarthritis. More than 50% of all patients with ankle osteoarthritis exhibit a substantial concomitant hindfoot deformity on the supramalleolar and/or inframalleolar level. Different treatment options for ankle osteoarthritis, including joint-preserving and non-joint-preserving surgical procedures, have been described in the current literature. Supramalleolar osteotomy is a joint-preserving option that can be considered in patients who have asymmetric ankle osteoarthritis, a partially preserved ankle joint, and a concomitant supramalleolar deformity. The primary goal of the supramalleolar osteotomy is to realign the hindfoot and, specifically, the spatial relationship between the talus and the tibia in order to restore normal ankle biomechanics and normalize load distribution within the ankle joint. Different surgical techniques of supramalleolar osteotomy that are based on the underlying deformity, e.g., varus versus valgus, are described. The major steps of the procedure, which are demonstrated in this video article, include (1) exposure of the distal end of the tibia, (2) determination of the osteotomy site, (3) performance of the supramalleolar osteotomy, (4) mobilization of the osteotomized distal end of the tibia, (5) internal fixation of the osteotomy site, (6) additional balancing, and (7) step-by-step wound closure. In some instances, additional procedures are required to balance the ankle joint, e.g., inframalleolar osteotomies, arthrodeses, ligament reconstructions, and tendon transfers. The postoperative rehabilitation requires non-weight-bearing activity for 6 to 8 weeks postoperatively. Intraoperative, perioperative, and postoperative complications can occur and are discussed in this article.
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Affiliation(s)
| | | | | | - Roxa Ruiz
- Kantonsspital Baselland, Liestal, Switzerland
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Harston A, Lazarides AL, Adams SB, DeOrio JK, Easley ME, Nunley JA. Midterm Outcomes of a Fixed-Bearing Total Ankle Arthroplasty With Deformity Analysis. Foot Ankle Int 2017; 38:1295-1300. [PMID: 28948831 DOI: 10.1177/1071100717731853] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We present our results with an INBONE I (Wright Medical, Memphis, TN) prosthesis that have a minimum of 4 to 10 years of follow-up and include a preoperative deformity analysis on outcomes. METHODS A consecutive series of 149 patients, from 2007 to 2011, at a single institution were enrolled. Pain and patient-reported function were assessed preoperatively and at yearly follow-ups. We analyzed the data for complications, reoperations, and failures (defined as undergoing revision for exchange or removal of one or both metallic components for any reason). Patients were also grouped according to coronal plane tibiotalar alignment; either ≥10 degrees or <10 degrees, and these outcomes were compared. Our follow-up ranged from 48 to 113 months (average 5.9 years). RESULTS There was significant improvement ( P < .05) in the visual analog scale for pain, American Orthopaedic Foot & Ankle Society hindfoot scale, Short Musculoskeletal Function Assessment, and Short Form 36-Item Health Survey scores at most recent follow-up. There were 14 implant failures with overall survivorship of 90.6% (135/149). Reasons for failure included cysts/loosening (7), talar subsidence (4), fractured component (1), impingement pain (1), and infection (1). Seventy-two patients (48.3%) with preoperative coronal plane deformity of ≥10 degrees varus or valgus were compared to 78 patients (51.7%) with <10 degrees deformity. There was no difference in patient outcome scores or revision rates between these patient groups. There was a statistically significant difference ( P = .039) in reoperation rates among patients with ≥10 degrees deformity (22.2%) compared to those without such a deformity (37.7%) Conclusion: Patients who underwent INBONE I fixed-bearing total ankle arthroplasty demonstrated significant improvement in outcomes at a mean of 5.9 years. Catastrophic talar component collapse did occur (2.7% of cases), but relatively rarely. The patients with preoperative coronal plane tibiotalar deformity had similar pain relief, function, and need for revision of implant components. Despite the presumed shortcomings of the INBONE I's design, this implant showed promising results, with or without deformity, at midterm follow-up with survivorship of 90.6%. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Andrew Harston
- 1 Duke University Orthopaedic Department, Durham, NC, USA
| | | | - Samuel B Adams
- 1 Duke University Orthopaedic Department, Durham, NC, USA
| | - James K DeOrio
- 1 Duke University Orthopaedic Department, Durham, NC, USA
| | - Mark E Easley
- 1 Duke University Orthopaedic Department, Durham, NC, USA
| | - James A Nunley
- 1 Duke University Orthopaedic Department, Durham, NC, USA
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Abstract
Distal tibial malalignment can result from posttraumatic malunion, physeal disturbances, congenital or metabolic diseases, and degenerative arthritis. Malalignment leads to an altered load distribution across the joint leading to early ankle joint arthritis. If a substantial part of the joint is salvageable, ankle fusion or joint replacement is not always the best option. Realignment of the distal tibia with a joint-sparing supramalleolar osteotomy is a valuable procedure in correcting deformity at the distal tibia. The goal of a supramalleolar osteotomy is to restore axial alignment. Several studies have demonstrated the successes of the osteotomy in improving function and relieving pain.
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Affiliation(s)
- Varun Chopra
- PMSR/RRA, Highlands/Presbyterian St. Luke's Podiatric Surgical Residency Program, 1719 East 19th Avenue, Denver, CO 80218, USA
| | - Paul Stone
- PMSR/RRA, Highlands/Presbyterian St. Luke's Podiatric Surgical Residency Program, 1719 East 19th Avenue, Denver, CO 80218, USA.
| | - Alan Ng
- PMSR/RRA, Highlands/Presbyterian St. Luke's Podiatric Surgical Residency Program, 1719 East 19th Avenue, Denver, CO 80218, USA
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25
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Hintermann B, Ruiz R, Barg A. Novel Double Osteotomy Technique of Distal Tibia for Correction of Asymmetric Varus Osteoarthritic Ankle. Foot Ankle Int 2017; 38:970-981. [PMID: 28670918 DOI: 10.1177/1071100717712543] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A most challenging condition for balancing a varus arthritic ankle is the presence of a defect in the medial tibial plafond. After our initial results with a medial tibial plafondplasty did not fulfill our expectations of success, we hypothesized that adding a correcting supramalleolar osteotomy of the distal tibia would move the loading force to the tibiotalar joint more medially and move the center of rotation of the talus more laterally. In this study, we analyzed midterm clinical and radiographic outcomes in patients with double tibial osteotomy. METHODS Between January 2005 and February 2010, 20 patients were treated with a medial tibial plafondplasty and a medial supramalleolar osteotomy of the distal tibia. The mean age of the patients was 44 ± 12 years (range, 17-60 years). Follow-up averaged 5.9 ± 2.1 years (range, 4-11.2 years). Weight-bearing radiographs were used to assess osteotomy union and hindfoot alignment. RESULTS There were no intraoperative or perioperative complications. The average VAS pain score decreased significantly from 7.9 ± 1.3 (range, 6-10) to 1.3 ± 1.6 (range, 0-7). The average AOFAS hindfoot score increased significantly from 49 ± 15 points (range, 36-68) preoperatively to 86 ± 12 points (range, 66-96) postoperatively. The varus tilt improved significantly from 19.4° ± 8.2° (range, 6°-32°) to 6.9° ± 3.9° (range, 1°-12°). CONCLUSION The novel double osteotomy was found to be an efficient and successful method to restore tibiotalar joint congruency and to normalize hindfoot alignment. LEVEL OF EVIDENCE Level IV, prospective cohort study.
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Affiliation(s)
- Beat Hintermann
- 1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Roxa Ruiz
- 1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Alexej Barg
- 2 Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Gauvain TT, Hames MA, McGarvey WC. Malalignment Correction of the Lower Limb Before, During, and After Total Ankle Arthroplasty. Foot Ankle Clin 2017; 22:311-339. [PMID: 28502351 DOI: 10.1016/j.fcl.2017.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
One of the main challenges in ankle replacement is correction of any deformities in the operative limb. Deformity can be found proximal and distal to the ankle joint as well as in the ankle joint. There are static and dynamic deformities that can create unbalanced ankle joints causing early and often catastrophic failure. Surgeons must recognize the deformities that are present and use sound judgment to balance the ankle joint with procedures before, during, or after total ankle implantation. This article helps clinicians to identify deformity and provides a basic template to consider how to address each challenge.
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Affiliation(s)
- Taggart T Gauvain
- Department of Orthopaedic Surgery, University of Texas Health Science Center-Houston, 10905 Memorial Hermann Drive, Suite 130 Pearland, Houston, TX 77584, USA
| | - Michael A Hames
- Private Practice Orthopaedics, 1 W Medical Ct Wichita Falls, Wichita Falls, TX 76310, USA
| | - William C McGarvey
- Department of Orthopaedic Surgery, University of Texas Health Science Center-Houston, 10905 Memorial Hermann Drive, Suite 130 Pearland, Houston, TX 77584, USA.
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Abstract
Patients presenting with end-stage ankle arthritis with coronal plane talar deformities have a variety of complex multidirectional deformities that require careful preoperative assessment and a clear understanding of the pathophysiology. Surgeons managing these patients with total ankle arthroplasty need to be familiar with extra-articular and intra-articular surgical methods to correct pes planus and pes cavus deformities, including bony procedures and soft tissue procedures. Performing these procedures in 1 or 2 stages depends on surgeon preference and the severity of the deformities. This article recommends a two-staged reconstruction for more severely deformed feet.
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Affiliation(s)
- Andrew Dodd
- Department of Surgery, University of Calgary, Bone & Joint Clinic, South Health Campus, 4448 Front Street Southeast, Calgary, Alberta, T3M 1M4, Canada.
| | - Timothy R Daniels
- Department of Surgery, St. Michael's Hospital, University of Toronto, Suite 800, 55 Queen Street East, Toronto, Ontario M5C-1R6, Canada
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Zhao H, Zhang Y, Hu D, Li Y, Liang X, Liu C, Wang J. [Supramalleolar osteotomy treatment of varus ankle osteoarthritis with or without fibular osteotomy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:284-289. [PMID: 29806255 DOI: 10.7507/1002-1892.201611110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the functional and radiological outcomes of supramalleolar osteotomy (SMOT) between with and without fibular osteotomy for varus ankle osteoarthritis. Methods Between April 2009 and April 2014, 41 patients (41 feet) with mid-staged varus ankle osteoarthritis were treated with SMOT. Fibular osteotomy was not performed in 19 cases (group A), and fibular osteotomy was performed in 22 cases (group B). There was no significant difference in gender, age, side, body mass index, osteoarthritis stage, pathogeny, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind score, ankle osteoarthritis scale (AOS) pain and function scores, range of motion (ROM) of the ankle joint, tibial articular surface angle (TAS), talar tilt angle (TT), tibiocrural angle (TC), and tibial lateral surface angle (TLS) between 2 groups ( P>0.05). The bone union was observed after operation, and functional and radiological outcomes were compared between 2 groups at last follow-up. Results All incisions healed by stage I, and no surgery related complications occurred. The mean follow-up time was 36.6 months (range, 16-55 months). Pain and limited activity were observed in 1 case of groups A and B respectively, and ankle arthrodesis was performed. All cases achieved bony union; the bone union time was (3.6±0.4) months in group A and (3.9±0.7) months in group B, showing no significant difference ( t=1.61, P=0.12). At last follow-up, no significant difference was found in TAS, TLS, TT, and TC between groups ( P>0.05). However, group B was significantly better than group A in improvement of TT and TC ( P<0.05). The AOFAS ankle-hind score, AOS pain and function scores, ROM of the ankle joint showed no significant difference between groups ( P>0.05). According to the modified Takakura stage, the improvement rates of groups A and B were 55.6% and 57.1%, respectively; no significant difference was found between 2 groups ( χ2=0.01, P=0.92). Conclusion SMOT with fibular osteotomy is helpful in correction of TT and TC in patients with relative longer fibula.
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Affiliation(s)
- Hongmou Zhao
- Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054, P.R.China
| | - Yan Zhang
- Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054, P.R.China
| | - Dong Hu
- Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054, P.R.China
| | - Yi Li
- Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054, P.R.China
| | - Xiaojun Liang
- Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054,
| | - Cheng Liu
- Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054, P.R.China
| | - Junhu Wang
- Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an Shaanxi, 710054, P.R.China
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Zhao H, Liang X, Li Y, Yu G, Niu W, Zhang Y. The role of fibular for supramalleolar osteotomy in treatment of varus ankle arthritis: a biomechanical and clinical study. J Orthop Surg Res 2016; 11:127. [PMID: 27776517 PMCID: PMC5078953 DOI: 10.1186/s13018-016-0462-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/28/2016] [Indexed: 12/18/2022] Open
Abstract
Background Supramalleolar osteotomy (SMOT) is a well-accepted treatment method for mid-stage varus ankle osteoarthritis (OA). However, few studies have examined the role of fibular osteotomy in SMOT. The objective of the current study was to compare the biomechanical and clinical outcomes of SMOT with and without fibular osteotomy. Methods Eight cadaveric lower legs with 10° varus/valgus SMOT models were tested using a Tekscan ankle sensor. Tibiotalar joint contact with and without fibular osteotomy conditions were compared. Forty-one varus ankle OA patients treated with SMOT were included; 22 underwent fibular osteotomy, and 19 did not. The Maryland foot score and radiological angles were used for clinical evaluation. Results The mean contact area and pressure did not differ significantly between normal and varus/valgus conditions with the fibula preserved. After fibular osteotomy, the mean contact area decreased and the mean contact pressure increased significantly in varus and valgus conditions (P < 0.01). The loading center moved to the opposite direction with and without fibular osteotomy in varus/valgus conditions. After a mean follow-up of 36.6 months (range 17–61), there was no significant difference in the Maryland scores of the two groups. However, in the fibular osteotomy group, the talar tilt angle decreased (P < 0.05), and the tibiocrural angle improved significantly (P < 0.01). Conclusions Fibular osteotomy facilitates the translation of tibiotalar contact pressure and is helpful for varus ankle realignment in patients with large talar tilts and small tibiocrural angles.
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Affiliation(s)
- Hongmou Zhao
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China
| | - Xiaojun Liang
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China.
| | - Yi Li
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China
| | - Guangrong Yu
- Foot and Ankle Surgery Department, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Wenxin Niu
- Laboratory of Biomechanics, Tongji University School of Medicine, Shanghai, 200092, China
| | - Yan Zhang
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, China
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Hongmou Z, Xiaojun L, Yi L, Hongliang L, Junhu W, Cheng L. Supramalleolar Osteotomy With or Without Fibular Osteotomy for Varus Ankle Arthritis. Foot Ankle Int 2016; 37:1001-7. [PMID: 27188695 DOI: 10.1177/1071100716649926] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Supramalleolar osteotomy (SMOT) is an alternative operative procedure for the management of early and midstage varus ankle arthritis. However, whether fibular osteotomy is needed is controversial. The purpose of the current study was to evaluate the functional and radiologic outcomes of pre- and postoperative SMOT, and to compare the outcomes between patients with and without fibular osteotomy. METHODS Forty-one Takakura stage 2 and 3 varus ankle osteoarthritis patients treated with SMOT were included. Fourteen males and 27 females with a mean age of 50.7 (range, 32-71) years were followed with a mean of 36.6 (range, 17-61) months. There were 22 cases with fibular osteotomy and 19 without. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Maryland foot score, and Ankle Osteoarthritis Score (AOS) were used for pre- and postoperative functional evaluation. The tibial articular surface angle (TAS), talar tilt (TT), tibiocrural angle (TC), and tibial lateral surface angle (TLS) were evaluated pre- and postoperatively. RESULTS At the last follow-up, the mean AOFAS score (from 50.8 to 83.1 points) and Maryland score (from 58.3 to 81.6 points) in overall were improved (P < .01); the mean AOS pain (from 42.6 to 26.1 points) and function (from 53.4 to 36.8 points) scores were decreased (P < .01). For radiologic evaluation, all the included parameters were improved (P < .05) except TLS. The mean Takakura stage was decreased (P < .01). No significant difference could be detected in comparing the functional outcomes between those with and without fibular osteotomy. However, in the fibular osteotomy group, TT was decreased (P < .05) and TC was improved (P < .01) significantly. CONCLUSION SMOT was promising, with substantial functional improvement and malalignment correction for varus ankle arthritis. Fibular osteotomy may be necessary in cases with large TT and small TC angles. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Zhao Hongmou
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China
| | - Liang Xiaojun
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China
| | - Li Yi
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China
| | - Liu Hongliang
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China
| | - Wang Junhu
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China
| | - Liu Cheng
- Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China
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31
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Zhu Y, Xu XY, Wang BB. Recent Advances in Foot and Ankle Surgery in Mainland China: Correction of Severe Foot and Ankle Deformities. Foot Ankle Clin 2016; 21:237-47. [PMID: 27261804 DOI: 10.1016/j.fcl.2016.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Foot and ankle physicians in China encounter quite a large amount of severe and complex deformities. The main cause of severe ankle and foot deformity is trauma, while the other causes may be neuromuscular diseases, improper reduction and fixation and so on. Staged procedure may sometimes be a safer way to correct deformities in the presence of severe soft tissue contracture. Periarticular osteotomy combined with soft tissue balancing can be used in treating severe varus ankle arthritis, including stage IIIb cases and patients with talar tilt of more than 10 degrees.
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Affiliation(s)
- Yuan Zhu
- Shanghai Ruijin Hospital, Shanghai Jiaotong university school of medicine, 197 Ruijin Er Road, Shanghai 200025, China
| | - Xiang-Yang Xu
- Shanghai Ruijin Hospital, Shanghai Jiaotong university school of medicine, 197 Ruijin Er Road, Shanghai 200025, China.
| | - Bi-Bo Wang
- Shanghai Ruijin Hospital, Shanghai Jiaotong university school of medicine, 197 Ruijin Er Road, Shanghai 200025, China
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32
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Nüesch C, Huber C, Paul J, Henninger HB, Pagenstert G, Valderrabano V, Barg A. Mid- to Long-term Clinical Outcome and Gait Biomechanics After Realignment Surgery in Asymmetric Ankle Osteoarthritis. Foot Ankle Int 2015; 36:908-18. [PMID: 25795650 DOI: 10.1177/1071100715577371] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Joint-preserving, realignment surgical procedures have gained increasing popularity as treatment of asymmetric early- and mid-stage ankle osteoarthritis. The aim of the present study was to quantify bilateral gait biomechanics in patients who underwent ankle realignment surgery by supramalleolar osteotomies. METHODS Eight patients, a minimum of 7 years after realignment surgery, and 8 healthy controls were included in this study. Three-dimensional instrumented gait analysis was used to assess spatiotemporal parameters, bilateral joint angles, and moments. Furthermore, a clinical evaluation on pain, ankle function, and quality of life was performed. RESULTS Compared with the healthy controls, the patients walked more slowly, had a smaller sagittal hindfoot range of motion on their affected leg, and had a lower peak ankle dorsiflexion moment (P < .05). There were no significant differences compared with controls for the ranges of motion in the foot segments of the nonaffected foot and for the knee and hip joint ranges of motion and peak moments of both legs. Additionally, patients and controls did not differ in the quality of life score. However, in the pain subscore, the patients reported significantly more pain than the healthy persons. CONCLUSION Despite different gait biomechanics of the affected foot after ankle realignment surgery, the quality of life for patients was comparable to that of healthy controls. Therefore, supramalleolar osteotomies should be considered as a promising treatment option in patients with asymmetric non-end-stage ankle osteoarthritis. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Corina Nüesch
- Orthopaedic Department, University Hospital of Basel, Basel, Switzerland
| | - Cora Huber
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedics, Hannover Medical School, Hannover, Germany Center of Biomechanics and Calorimetry, University of Basel, Basel, Switzerland
| | - Jochen Paul
- Orthopaedic Department, University Hospital of Basel, Basel, Switzerland
| | - Heath B Henninger
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Geert Pagenstert
- Orthopaedic Department, University Hospital of Basel, Basel, Switzerland
| | | | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Mulhern JL, Protzman NM, Brigido SA, Deol PPS. Supramalleolar Osteotomy: Indications and Surgical Techniques. Clin Podiatr Med Surg 2015; 32:445-61. [PMID: 26117578 DOI: 10.1016/j.cpm.2015.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Supramalleolar osteotomies are a surgical treatment option for asymmetric varus or valgus ankle arthritis where at least 50% of the joint surface is spared. Procedure selection requires significant preoperative planning for appropriate execution. Thus, the surgeon must be familiar with the principles of deformity correction. With appropriate patient selection and proper preoperative planning, the procedure has been shown to yield excellent results, redistributing forces more evenly across the ankle joint by restoring the mechanical axis of the lower leg with minimal complications.
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Affiliation(s)
- Jennifer L Mulhern
- Foot and Ankle Department, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA 18017, USA
| | - Nicole M Protzman
- Clinical Education and Research Department, Coordinated Health, 3435 Winchester Road, Allentown, PA 18104, USA
| | - Stephen A Brigido
- Foot and Ankle Department, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA 18017, USA.
| | - Premjit Pete S Deol
- Orthopaedics Department, Panorama Orthopedics & Spine Center, 660 Golden Ridge Road, Suite 250, Golden, CO 80401, USA
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Affiliation(s)
- Randall C Marx
- The San Antonio Orthopedic Group, 2829 Babcock Road, Suite #700, San Antonio, TX 78229
| | - Mark S Mizel
- PO Box 740611, Boynton Beach, FL 33474. E-mail address:
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Abstract
A variety of surgical procedures are utilized for management of ankle osteoarthritis. The most common etiology in patients with ankle osteoarthritis is post-traumatic often resulting in asymmetric ankle osteoarthritis with concomitant valgus or varus deformity. A substantial part of tibiotalar joint is often preserved, therefore, in appropriate patients, joint-preserving surgery holds the potential to be a superior treatment option than joint-sacrificing procedures including total ankle replacement or ankle arthrodesis. This review is designed to describe indications and contraindications for single-stage supramalleolar realignment surgery. Complications associated with this type of surgery and postoperative outcome are highlighted using recent literature.
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Affiliation(s)
- Alexej Barg
- Head Foot and Ankle Surgery, Department of Orthopedic Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland,
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