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Choi JY, Suh JS. Joint preserving procedures for Takakura stage IIIB varus ankle osteoarthritis. BMJ Case Rep 2024; 17:e260585. [PMID: 38914523 DOI: 10.1136/bcr-2024-260585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
A man in his early 70s with right Takakura stage IIIB varus ankle osteoarthritis underwent medial opening wedge supramalleolar osteotomy with inframalleolar correction as joint preserving procedure. We also performed anteroinferior tibiofibular ligament (AITFL) resection with fibular shortening valgisation osteotomy to enhance the talar tilt correction. Postoperative decrease in talar tilt with dramatic symptom improvement was achieved. Performing the AITFL resection with fibular shortening valgisation osteotomy plus concomitant supramalleolar osteotomy and inframalleolar correction for Takakura stage IIIB varus ankle osteoarthritis resulted in successful improvement in talar tilt by making room for the valgus deviation of the talus.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Korea (the Republic of)
| | - Jin Soo Suh
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Korea (the Republic of)
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Choi JY, Suh JS. Comparison of supramalleolar and inframalleolar correction for Takakura stage IIIB ankle arthritis in a single patient. BMJ Case Rep 2024; 17:e258897. [PMID: 38383123 PMCID: PMC10882454 DOI: 10.1136/bcr-2023-258897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
A man in his early 60s with bilateral Takakura stage IIIB varus ankle arthritis underwent calcaneal osteotomy on the right side and supramalleolar osteotomy (SMO) with fibular osteotomy on the left side. Both sides underwent identical procedures, including multiple drilling of the denuded talar dome and gutter, deltoid ligament release, anterior talofibular ligament (ATFL) reconstruction and posterior tibial tendon (PTT) lengthening. This aimed to minimise patient-related factors when assessing correction efficacy. Both procedures demonstrated a similar degree of improvement in talar tilt. Supramalleolar correction contributed more significantly to lateralising the talar centre, while greater improvement in preoperative hindfoot varus was achieved through inframalleolar correction.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Korea (the Republic of)
| | - Jin Soo Suh
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Korea (the Republic of)
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El-Adly W, Adam FF, Kamel MS, Osman AE. Functional and radiographic assessments of post-traumatic asymmetrical ankle osteoarthritis treatment using supramalleolar osteotomies. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1095-1101. [PMID: 37943337 PMCID: PMC10857950 DOI: 10.1007/s00590-023-03773-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE This study's objective is to assess the effectiveness of supramalleolar osteotomies (SMOT) in the treatment of asymmetrical ankle osteoarthritis in terms of the improvement in alignment assessed radiographically and its impact on symptoms measured by the American Orthopedic Foot and Ankle Society ankle-hindfoot score (AOFAS ankle-hindfoot score). METHODS Twelve patients participated in this prospective observational case series study. Standing anteroposterior, true lateral, and mortise views radiographs were taken. For preoperative planning, the lateral distal tibial angle (LDTA), talar tilt (TT), talocrural angle (TCA), and anterior distal tibial angle (ADTA) were all measured. A medial opening wedge osteotomy mainly was used to treat the varus arthritis ankle. A further oblique fibular osteotomy is frequently necessary. RESULTS The male-to-female ratio was 3:1, and the mean age of the patients was 26.25 ± 13.032 years. There were highly statistically significant differences between pre-and post-operative AOFAS ankle-hindfoot score (p < 0.001). Statistically significant differences concerning ankle range of motion (p = 0.002, < 0.001) of dorsiflexion and planter flexion were detected. Comparison between pre-and post-operative patients' radiology characteristics shows statistically significant differences concerning TT (p = 0.016) and LDTA (p = 0.046). CONCLUSION SMOT is very effective in the treatment of post-traumatic ankle osteoarthritis and postpones ankle fusion or total ankle replacements. This surgery significantly improves functional and radiological outcomes as well as the range of motion in the ankle. Meticulous preoperative planning by radiological measurements of different angles around the ankle is considered the crucial factor in success of that operation.
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Affiliation(s)
- Wael El-Adly
- Orthopedic Surgery Department, Assiut University, Assiut, Egypt.
- Orthopedic Surgery Department, Assiut University Hospital, University Street, Assiut, 71515, Egypt.
| | | | | | - Ahmed E Osman
- Orthopedic Surgery Department, Assiut University, Assiut, Egypt
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Zhao B, Liu W, Zhao Y, Wahafu P, Wang X, Qi L, Wang C. Efficacy of supramalleolar osteotomy in the treatment of traumatic ankle joint varus deformity in adolescents. J Orthop Surg Res 2023; 18:749. [PMID: 37789419 PMCID: PMC10548641 DOI: 10.1186/s13018-023-04239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Supramalleolar osteotomy (SMOT) has emerged as a valuable treatment for ankle varus deformity; however, there are fewer reports of treatment outcomes in adolescents. The purpose of this study was to investigate the radiologic and clinical outcomes of SMOT for the treatment of traumatic ankle joint varus deformity (TAVD) in adolescents. METHODS We reviewed 32 adolescent cases who underwent SMOT between February 2017 and February 2022 for TAVD. Radiologic assessment included tibial anterior surface angle (TAS), talar tilt angle (TT), and tibial lateral surface angle (TLS) preoperatively and at 3 months and 12 months postoperatively, and clinical assessment was performed using American Orthopaedic Foot and Ankle Society (AOFAS) scores, Visual Analogue Scale (VAS) scores, and ankle dorsiflexion-plantarflexion ROM including preoperative and 6 months postoperative and 12 months postoperative. RESULTS All 32 patients were followed up completely with a mean follow-up of (20.3 ± 3.2) months. From the radiologic outcomes, the mean preoperative TAS improved from 61.53 ± 3.74 to 88 ± 1.72 at 12 months postoperatively, the mean preoperative TT decreased from 2.25 ± 1.32 to 0.5 ± 0.57 at 12 months postoperatively, the mean preoperative TLS improved from 76.72 ± 0.21 to 79.34 ± 1.52 at 12 months postoperatively, the differences between the above preoperative and 12 months postoperative radiologic outcomes were statistically significant (p < 0.05), the mean preoperative AOFAS score improved from 65.5 ± 9.40 to 92.34 ± 4.00 at 12 months postoperatively, the mean preoperative VAS score decreased from 2.44 ± 1.24 to 0.78 ± 0.75 at 12 months postoperatively, and the mean preoperative range of motion (ROM) of ankle improved from 50.16 ± 7.46 to 55.78 ± 4.77 at 12 months postoperatively. The differences between the above preoperative and 12 months postoperative clinical results were statistically significant (p < 0.05). CONCLUSION Our study demonstrated that SMOT was effective in correcting TAVD and significantly improving ankle function in adolescents, and that it is an efficient and successful method for restoring ankle joint congruence and normal hindfoot alignment.
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Affiliation(s)
- Bo Zhao
- The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People's Republic of China
| | - Wei Liu
- The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People's Republic of China
| | - Yaqiong Zhao
- The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People's Republic of China
| | - Paerhati Wahafu
- The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People's Republic of China
| | - Xue Wang
- The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People's Republic of China
| | - Ling Qi
- The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People's Republic of China
| | - Chengwei Wang
- The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, People's Republic of China.
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Flury A, Hodel S, Ongini E, Trache T, Hasler J, Wirth SH, Viehöfer AF, Imhoff FB. The Unloading Effect of Supramalleolar Versus Sliding Calcaneal Osteotomy for Treatment of Osteochondral Lesions of the Medial Talus: A Biomechanical Study. Orthop J Sports Med 2023; 11:23259671231176295. [PMID: 37810740 PMCID: PMC10552459 DOI: 10.1177/23259671231176295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/25/2023] [Indexed: 10/10/2023] Open
Abstract
Background In patients with osteochondral lesion, defects of the medial talus, or failed cartilage surgery, a periarticular osteotomy can unload the medial compartment. Purpose To compare the effects of supramalleolar osteotomy (SMOT) versus sliding calcaneal osteotomy (SCO) for pressure redistribution and unloading of the medial ankle joint in normal, varus-aligned, and valgus-aligned distal tibiae. Study Design Controlled laboratory study. Methods Included were 8 cadaveric lower legs with verified neutral ankle alignment (lateral distal tibial angle [LDTA] = 0°) and hindfoot valgus within normal range (0°-10°). SMOT was performed to modify LDTA between 5° valgus, neutral, and 5° varus. In addition, a 10-mm lateral SCO was performed and tested in each position in random order. Axial loading (700 N) of the tibia was applied with the foot in neutral alignment in a customized testing frame. Pressure distribution in the ankle joint and subtalar joint, center of force, and contact area were recorded using high-resolution Tekscan pressure sensors. Results At neutral tibial alignment, SCO unloaded the medial joint by a mean of 10% ± 10% or 66 ± 51 N (P = .04) compared with 6% ± 12% or 55 ± 72 N with SMOT to 5° valgus (P = .12). The achieved deload was not significantly different (ns) between techniques. In ankles with 5° varus alignment at baseline, SMOT to correct LDTA to neutral insufficiently addressed pressure redistribution and increased medial load by 6% ± 9% or 34 ± 33 N (ns). LDTA correction to 5° valgus (10° SMOT) unloaded the medial joint by 0.4% ± 14% or 20 ± 75 N (ns) compared with 9% ± 11% or 36 ± 45 N with SCO (ns). SCO was significantly superior to 5° SMOT (P = .017) but not 10° SMOT. The subtalar joint was affected by both SCO and SMOT, where SCO unloaded but SMOT loaded the medial side. Conclusion SCO reliably unloaded the medial compartment of the ankle joint for a neutral tibial axis. Changes in the LDTA by SMOT did not positively affect load distribution, especially in varus alignment. The subtalar joint was affected by SCO and SMOT in opposite ways, which should be considered in the treatment algorithm. Clinical Relevance SCO may be considered a reliable option for beneficial load-shifting in ankles with neutral alignment or 5° varus malalignment.
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Affiliation(s)
- Andreas Flury
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Sandro Hodel
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Esteban Ongini
- Institute for Biomechanics, Laboratory for Orthopaedic Biomechanics, ETH Zürich, Balgrist Campus, Zürich, Switzerland
| | - Tudor Trache
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Julian Hasler
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Stephan H. Wirth
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Arnd F. Viehöfer
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Florian B. Imhoff
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
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Christidis P, Lampridis V, Kalitsis C, Kantas T, Biniaris G, Gougoulias N. Supramalleolar osteotomies for ankle arthritis: a systematic review. Arch Orthop Trauma Surg 2023; 143:5549-5564. [PMID: 37010603 DOI: 10.1007/s00402-023-04867-1] [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: 11/07/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION We investigated the mid-term outcomes of supramalleolar osteotomies regarding "survivorship" [before ankle arthrodesis (AA) or total ankle replacement (TAR)], complication rate and adjuvant procedures required. MATERIAL AND METHODS PubMed, Cochrane and Trip Medical Database were searched from January 01, 2000. Studies reporting on SMOs for ankle arthritis, in minimum of 20 patients aged 17 or older, followed for a minimum of two years, were included. Quality assessment was performed with the Modified Coleman Methodology Score (MCMS). A subgroup analysis of varus/valgus ankles was performed. RESULTS Sixteen studies met the inclusion criteria, with 866 SMOs in 851 patients. Mean age of patients was 53.6 (range 17-79) years, and mean follow-up was 49.1 (range 8-168) months. Of the arthritic ankles (646 ankles), 11.1% were classified as Takakura stage I, 24.0% as stage II, 59.9% as stage III and 5.0% as stage IV. The overall MCMS was 55.2 ± 9.6 (fair). Eleven studies (657 SMOs) reported on "survivorship" of SMO, before arthrodesis (2.7%), or total ankle replacement (TAR) (5.8%) was required. Patients required AA after an average of 44.6 (range 7-156) months, and TAR after 36.71 (range 7-152) months. Hardware removal was required in 1.9% and revision in 4.4% of 777 SMOs. Mean AOFAS score was 51.8 preoperatively, improving to 79.1 postoperatively. Mean VAS was 6.5 preoperatively and improved to 2.1 postoperatively. Complications were reported in 5.7% (44 out of 777 SMOs). Soft tissue procedures were performed in 41.0% (310 out of 756 SMOs), whereas concomitant osseous procedures were performed in 59.0% (446 out of 756 SMOs). SMOs performed for valgus ankles failed in 11.1% of patients, vs 5.6% in varus ankles (p < 0.05), with disparity between the different studies. CONCLUSIONS SMOs combined with adjuvant, osseous and soft tissue, procedures, were performed mostly for arthritic ankles of stage II and III, according to the Takakura classification and offered functional improvement with low complication rate. Approximately, 10% of SMOs failed and patients required AA or TAR, after an average of just over 4 years (50.5 months) after the index surgery. It is debatable whether varus and valgus ankles treated with SMO reveal different success rates.
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Affiliation(s)
- Panagiotis Christidis
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece
| | - Vasileios Lampridis
- Department of Trauma and Orthopedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Christos Kalitsis
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece
| | - Theofanis Kantas
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece
| | - Georgios Biniaris
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece
| | - Nikolaos Gougoulias
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece.
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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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Lim JW, Kang SJ, Im JM, Kwon SH, Jung HG. Evaluation of clinico-radiological outcome of fibular valgization osteotomy with supra-malleolar osteotomy in patients with ankle osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05822-w. [PMID: 37310443 DOI: 10.1007/s00264-023-05822-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/13/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE There are controversies about combining distal tibia medial opening-wedge osteotomy (DTMO) with fibular valgization osteotomy (FVO) when performing supramalleolar osteotomy (SMO) for medial ankle osteoarthritis. This study aimed to assess the effect of FVO on the coronal translation of the mechanical axis by comparing the improvement of radiological indices after DTMO with and without FVO. METHODS Forty-three ankles (mean follow-up: 42.0 months) were reviewed after SMO. Among them, 35/43 (81.4%) underwent DTMO with FVO, while 8/43 (18.6%) underwent DTMO only. To evaluate the effect of FVO radiologically, the medial gutter space (MGS) and talus centre migration (TCM) were measured. RESULTS Post-operatively, MGS and TCM were not significantly different after DTMO only and DTMO with FVO. However, the improvement of MGS was significantly higher in the combined FVO group (0.8 mm (standard deviation [SD] 0.8 mm) vs. 1.5 mm (SD 0.8 mm); p = 0.015). More lateral translation of the talus was achieved in the FVO group (5.1 mm (SD 2.3 mm) vs. 7.5 mm (SD 3.0 mm); p = 0.033). However, the changes in the MGS and TCM were not significantly correlated with the clinical outcomes (p > 0.05). CONCLUSION Our radiological evaluation confirmed a significant medial gutter space widening and lateral talar translation after the addition of FVO. The SMO with fibular osteotomy allows greater shifting of the talus and, therefore, the weight-bearing axis.
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Affiliation(s)
- Jung-Won Lim
- Department of Orthopaedic Surgery, Chung-Ang University Gwangmyeong Hospital, 110, Deokan-ro, Gyeonggi-do, 14353, Gwangmyeong-si, Republic of Korea
| | - Sung Jin Kang
- Department of Orthopaedic Surgery, Konkuk University Medical Centre, Konkuk University School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, 05030, Seoul, Republic of Korea
| | - Je-Min Im
- Department of Orthopaedic Surgery, Konkuk University Medical Centre, Konkuk University School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, 05030, Seoul, Republic of Korea
| | - Sae Him Kwon
- Department of Orthopaedic Surgery, Konkuk University Medical Centre, Konkuk University School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, 05030, Seoul, Republic of Korea
| | - Hong-Geun Jung
- Department of Orthopaedic Surgery, Konkuk University Medical Centre, Konkuk University School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, 05030, Seoul, Republic of Korea.
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Choi JY, Park SJ, Suh JS. Does ankle arthrodesis induce satisfactory changes in the medial longitudinal arch height of the foot for severe varus ankle arthritis? INTERNATIONAL ORTHOPAEDICS 2023; 47:107-115. [PMID: 36462088 DOI: 10.1007/s00264-022-05645-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/22/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE We designed this study to determine how changes in coronal ankle alignment affect sagittal alignment of the foot. Specifically, we focused on the changes in medial longitudinal arch height, which could be reflected by the medial cuneiform height (MCH), Meary's angle, and calcaneal pitch angle (CPA). METHODS We retrospectively analyzed the radiographic findings of 37 patients who underwent open ankle arthrodesis without inframalleolar correction (such as first metatarsal dorsal closing wedge osteotomy, calcaneal osteotomies, tendon transfers, or tarsal joint arthrodesis) of severe varus ankle arthritis. The inclusion criterion was a pre-operative tibial axis to talar dome angle of 80 degrees or less. The enrolled patients were divided into two groups according to the post-operative decrease in MCH (≥ 2 mm or < 2 mm). RESULTS A post-operative MCH decrease of ≥ 2 mm was observed in 43.2% (16 patients). Although the degree of coronal ankle varus correction was similar, the decrease in the Meary's angle was significantly greater in the group with a post-operative MCH decrease of ≥ 2 mm than in those with < 2 mm (- 4.1 degrees vs. - 1.3 degrees, P = 0.01). The changes in CPA were not significantly different (P = 0.172). CONCLUSION Correction of ankle varus deformity via ankle arthrodesis could lead to a decrease in the medial longitudinal arch height in less than half of the enrolled patients. In these patients, a cavus component of the foot might be an important factor in determining a successful sagittal foot alignment change, while the CPA was maintained post-operatively.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-Si, Gyeonggi-Do, South Korea
| | - Seung Jun Park
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-Si, Gyeonggi-Do, South Korea
| | - Jin Soo Suh
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-Si, Gyeonggi-Do, South Korea.
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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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Burssens A, Susdorf R, Krähenbühl N, Peterhans U, Ruiz R, Barg A, Hintermann B. Supramalleolar Osteotomy for Ankle Varus Deformity Alters Subtalar Joint Alignment. Foot Ankle Int 2022; 43:1194-1203. [PMID: 35786021 DOI: 10.1177/10711007221108097] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although correction of ankle and hindfoot deformity after supramalleolar osteotomy has been investigated extensively, the specific effect on the subtalar joint alignment remains elusive. This can be attributed to the limitations of 2-dimensional measurements, which impede an exact quantification of the 3-dimensional subtalar joint alignment. Therefore, we determined both the ankle, hindfoot, and subtalar joint alignment before and after supramalleolar osteotomy using autogenerated 3-dimensional measurements based on weightbearing CT imaging. METHODS Twenty-nine patients with a mean age of 50.4±10.6 years were retrospectively analyzed in a pre-post study design using weightbearing CT. Inclusion criteria were correction of ankle varus deformity by an opening wedge (n = 22) or dome osteotomy (n = 7). Exclusion criteria consisted of an additional inframalleolar arthrodesis or osteotomy. Corresponding 3-dimensional bone models were reconstructed to compute following autogenerated measurements of the ankle- and hindfoot alignment: tibial anterior surface (TAS), tibiotalar surface (TTS), talar tilt (TT) angle, hindfoot angle (HA). In addition, the talocalcaneal angle (TCA) in the axial (TCAax), sagittal (TCAsag), and coronal (TCAcor) plane were measured to assess the subtalar joint alignment. RESULTS The preoperative radiographic parameters of the ankle joint alignment (TAS=88±4 degrees, TTS=82±7 degrees, TT=5.8±4.9 degrees) improved significantly relative to their postoperative equivalents (TAS = 93±5 degrees, TTS = 88±7 degrees, TT=4.2±4.5 degrees; P < .05). The following radiographic parameters of the hindfoot and subtalar joint alignment improved significantly from preoperatively (8.7±8.9 degrees, TCAax = 41±10 degrees, TCAsag = 48±10 degrees) to postoperatively (HA=4.5±8.6 degrees, TCAax = 38±9 degrees, TCAsag = 44±11 degrees; P < .05). No significant differences could be detected in the coronal plane alignment of the subtalar joint (TCAcor) pre- compared to postoperatively (P > .05). CONCLUSION This study quantified the 3-dimensional ankle, hindfoot, and subtalar joint alignment after a solitary supramalleolar osteotomy. We found alterations in the subtalar joint alignment, which occurred by 2 to 3 degrees in each anatomic plane. However, before recommendations can be given related to inframalleolar procedures in conjunction to supramalleolar osteotomies, further studies on the variation of subtalar joint alignment change are needed.
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Affiliation(s)
- Arne Burssens
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
- Department of Orthopaedics, University Hospital of Ghent, Ghent, OVL, Belgium
| | - Roman Susdorf
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Nicola Krähenbühl
- Department of Orthopaedics, University Hospital Basel, Basel, Switzerland
| | - Ursina Peterhans
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Roxa Ruiz
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Alexej Barg
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
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13
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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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14
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Choi JY, Suh JS. Effect of four combined procedures to achieve inframalleolar correction for advanced varus ankle arthritis. BMJ Case Rep 2022; 15:e249197. [PMID: 35725285 PMCID: PMC9214355 DOI: 10.1136/bcr-2022-249197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 11/04/2022] Open
Abstract
A man in his early 60s with Takakura stage IIIB varus ankle arthritis underwent four combined procedures (Dwyer's osteotomy with lateral displacement, superficial/deep deltoid ligament release, anterior talofibular ligament/calcaneofibular ligament reconstruction with suture tape augmentation and posterior tibial tendon lengthening). Decreased talar tilt and talar centre lateral shifting and improved hindfoot varus were observed 2 years postoperatively. Also, excellent clinical outcome could be achieved.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang-si, South Korea
| | - Jin Soo Suh
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang-si, South Korea
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15
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Ma XL, Ma JX, Zhao XW, Du YR, Wang Y, Bai HH, Lu B. Intra-articular opening wedge osteotomy for varus ankle arthritis with computer-assisted planning and patient-specific surgical guides: a retrospective case series. BMC Musculoskelet Disord 2022; 23:483. [PMID: 35597924 PMCID: PMC9123770 DOI: 10.1186/s12891-022-05437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Computer-assisted preoperative planning, combined with PSI has become an effective technique for treating complex limb deformities. The purpose of this study was to evaluate the efficacy and safety of the novel technique in corrective osteotomy for intra-articular varus ankle deformities associated with osteoarthritis and ankle instability. Methods Nineteen patients with intra-articular varus ankle arthritis were reviewed between April 2017 and June 2019, including ten men and nine women with a mean age of 58.3 ± 9.9 years (range, 38 to 76 years). All patients underwent intra-articular opening wedge osteotomy assisted by 3D virtual planning and PSI. Weight-bearing radiographs were used to assess the radiographic results, including TAS angle, TT angle, TMM angle, TC angle, TLS angle, opening-wedge angle, and wedge height. Functional outcomes were assessed by the AOFAS score, VAS score, and ROM of the ankle. Results The average follow-up time was 32.2 ± 9.0 months (range, 22 to 47 months). The average union time was 4.4 ± 0.9 months (range, 3.0 to 6.5 months). The TAS angle significantly changed from 84.1 ± 4.6° preoperatively to 87.7 ± 3.1° at the 1-year follow-up and 86.2 ± 2.6° at the latest follow-up. Similarly, the TT angle, TMM angle and TC angle changed significantly at the 1-year follow-up compared with the preoperative assessment and remained stable until the last follow-up. However, the TLS was not corrected significantly. The postoperative obtained opening-wedge angle, and wedge height showed no significant change with preoperative planning. The overall complication rate was 15.8%. The mean VAS score improved from 5.3 ± 0.6 to 2.7 ± 0.7. The mean AOFAS score improved from 56.2 ± 7.6 to 80.6 ± 4.6. However, the ROM showed no significant change. Conclusions Accurate correction and satisfactory functional recovery were attained with computer-assisted planning and PSI in the corrective osteotomy of intra-articular varus ankle deformities. Supplementary information The online version contains supplementary material available at 10.1186/s12891-022-05437-z.
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Affiliation(s)
- Xin-Long Ma
- Tianjin Hospital, Tianjin, 300211, China. .,Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin Hospital, Tianjin, 300050, China.
| | - Jian-Xiong Ma
- Tianjin Hospital, Tianjin, 300211, China. .,Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin Hospital, Tianjin, 300050, China.
| | - Xing-Wen Zhao
- Tianjin Hospital, Tianjin, 300211, China.,Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin Hospital, Tianjin, 300050, China.,Graduate School of Tianjin Medical University, Tianjin, 300070, China
| | - Yu-Ren Du
- Tianjin Hospital, Tianjin, 300211, China.,Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin Hospital, Tianjin, 300050, China
| | - Ying Wang
- Tianjin Hospital, Tianjin, 300211, China.,Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin Hospital, Tianjin, 300050, China
| | - Hao-Hao Bai
- Tianjin Hospital, Tianjin, 300211, China.,Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin Hospital, Tianjin, 300050, China
| | - Bin Lu
- Tianjin Hospital, Tianjin, 300211, China.,Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin Hospital, Tianjin, 300050, China
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16
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Yang Z, Cui L, Tao S, Zhao J, Wang L, Zhang F, Shao X. Comparisons between ankle distraction arthroplasty and supramalleolar osteotomy for treatment of post-traumatic varus ankle osteoarthritis. BMC Surg 2022; 22:178. [PMID: 35568850 PMCID: PMC9107238 DOI: 10.1186/s12893-022-01623-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ankle distraction arthroplasty and supramalleolar osteotomy were both options for post-traumatic varus ankle arthritis (VAA), but their comparative effectiveness was scarcely reported. This study aimed to compare the outcomes of two operative methods for treatment of Takakura-Tanaka stage 3 post-traumatic VAA. METHODS This was a retrospective study, comprising 73 consecutive patients who presented with Takakura-Tanaka stage 3 post-traumatic VAA treated by either ankle distraction arthroplasty (n = 32) or supramalleolar osteotomy (n = 41) from January 2016 to December 2019. All patients had a minimum 24-month follow-up assessments. The outcome measures were visual analog scale (VAS), the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, complications, patient-rated overall satisfaction and ankle function. RESULTS At an average of 32 months (range, 24-52 months) follow-up, significant improvement was observed for VAS, AOFAS, range of motion (ROM) and most radiographic parameters (except for TAS and TLS for ankle distraction arthroplasty group) compared to preoperative baselines (p < 0.05) for both groups. However, both groups did not differ significantly in terms of VAS or AOFAS, excellent and good rate (78.1% versus 85.4%, p = 0.422), overall rate of postoperative complications (28.1% vs. 17.1%, p = 0.257), or various radiographic parameters (e.g. tibial anterior surface angle, talar tilt angle and tibial lateral surface angle) (all p > 0.05). The ankle distraction arthroplasty group had a better postoperative ankle motion than did the supramalleolar osteotomy group, in terms of plantarflexion (37.8 ± 4.2 vs. 30.4 ± 3.6, p = 0.006), dorsiflexion (36.5 ± 6.4 vs. 28.3 ± 5.5, p = 0.004), varus (32.1 ± 4.5 vs. 27.1 ± 3.1, p = 0.017) and valgus (28.4 ± 3.7 vs. 25.2 ± 2.8, p = 0.046). CONCLUSIONS Both operative treatments are effective for Takakura-Tanaka stage 3 post-traumatic VAA. In practice, individualized treatment option tailored to the ankle condition and patients' specific need should be considered. LEVEL OF EVIDENCE III, retrospective comparative series.
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Affiliation(s)
- Zongyu Yang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China.,Department of Sports Medicine-Foot and Ankle Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei, 061001, Cangzhou, People's Republic of China
| | - Liang Cui
- Department of Sports Medicine-Foot and Ankle Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei, 061001, Cangzhou, People's Republic of China
| | - Shiwu Tao
- Department of Sports Medicine-Foot and Ankle Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei, 061001, Cangzhou, People's Republic of China
| | - Jianyong Zhao
- Department of Sports Medicine-Foot and Ankle Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei, 061001, Cangzhou, People's Republic of China
| | - Li Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Fengqi Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Xinzhong Shao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China. .,Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
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17
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Kim J, Henry JK, Kim JB, Lee WC. Dome Supramalleolar Osteotomies for the Treatment of Ankle Pain with Opposing Coronal Plane Deformities Between Ankle and the Lower Limb. Foot Ankle Int 2022; 43:474-485. [PMID: 34693786 DOI: 10.1177/10711007211050639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The dome-type osteotomy is a powerful technique for deformity correction of the limb. However, there is limited information about the utility of dome supramalleolar osteotomy (SMO) in ankle joint preservation surgery. This study aimed to describe the technique and indications for dome SMO in distal tibial malalignment. METHODS Twenty-three patients (23 ankles) who underwent dome SMO with a 2-year follow-up were reviewed. Dome SMO was indicated when there were opposing deformities in the ankle and lower limb mechanical axis (ie, varus ankle deformity with valgus lower limb alignment and vice versa) where inherent translation following conventional wedge-type osteotomies could worsen the deformity of the entire lower limb. Patients were divided into 2 groups based on preoperative ankle alignment: the varus ankle group (n = 11) and the valgus ankle group (n = 12). The radiographic correction was assessed using 6 parameters from weightbearing ankle and hindfoot alignment views. In addition, the lower limb mechanical axis was assessed with ankle center deviation (ACD) from the hip-knee (HK) line on the whole limb radiograph, and the weightbearing line (WBL) point was measured to identify changes in the weightbearing load within the ankle joint. RESULTS Preoperatively, the varus ankle group had varus ankle deformity (tibiotalar angle [TTA], 76.5 ± 5.8 degrees) with valgus lower limb mechanical axis, whereas the valgus ankle group had valgus ankle deformity (TTA, 99.1 ± 4.5 degrees) with varus lower limb mechanical axis alignment. Postoperatively, a significant improvement in the ankle alignment and the lower limb mechanical axis was observed in both groups. The ACD significantly changed toward the HK line, suggesting an improved lower limb mechanical axis, and the WBL point showed a significant shift of the weightbearing axis toward the uninvolved area within the ankle joint. CONCLUSION Dome SMO demonstrated a successful correction of local deformity while simultaneously realigning the hip-knee-ankle axis toward neutral. Additionally, an effective load shifting toward an uninvolved area within the ankle joint was observed. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | | | - Ji-Beom Kim
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea
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18
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Choi JY, Cho JH, Song TH, Suh JS. Radiographic Outcomes of Proximal vs Distal Syndesmotic Low Tibial Osteotomy. Foot Ankle Int 2022; 43:211-222. [PMID: 34384272 DOI: 10.1177/10711007211035784] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We aimed to determine whether the location of tibial osteotomy affects the outcome during low tibial osteotomy (LTO) with fibular osteotomy for varus ankle arthritis by comparing proximal syndesmotic (PS) and distal syndesmotic (DS) tibial osteotomy. METHODS We retrospectively reviewed the radiographic findings of 50 cases (among 47 patients) who underwent LTO with fibular osteotomy for varus ankle arthritis. The enrolled patients were divided into 2 groups according to the location of the tibial osteotomy: the PS group (25 cases, 24 patients) and the DS group (25 cases, 23 patients). Radiographic parameters were compared between the 2 groups. RESULTS There were no significant differences in tibial anterior and lateral surface angles, tibiomedial malleolar angle, talar center migration, and intermalleolar distance correction between the 2 groups (all P > .05). However, the decreases in talar tilt (TT) and talocrural angle (TCA) were more pronounced in the DS group than in the PS group (both P < .05). Among patients with TT ≥8 degrees, a greater decrease in TT (+1.0 degrees vs -2.8 degrees) and TCA was observed in the DS group, whereas the PS group demonstrated greater increases in TCA and intermalleolar distance (all P < .01). CONCLUSION In this series, DS tibial osteotomy combined with fibular osteotomy was a more effective operative option than PS tibial osteotomy to correct both extra- and intra-articular deformity for varus ankle arthritis. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Jin Ho Cho
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Tae Hun Song
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Jin Soo Suh
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
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19
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Choi JY, Lee GH, Suh JS. Low tibial valgization osteotomy for varus ankle arthritis - does age effect the outcome? Foot Ankle Surg 2021; 27:897-905. [PMID: 33376049 DOI: 10.1016/j.fas.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/17/2020] [Accepted: 12/04/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Evidence-based literature identifying the age limit for low tibial valgization osteotomy (LTO) is lacking to date. We addressed the following research questions: (1) is LTO effective for ankle arthritis in patients over 65 years?; (2) does patients' age alter the effectiveness of LTO?; and (3) does preoperative Takakura stage affect the degree of correction in patients over 65 years? METHODS We retrospectively reviewed the radiographic and clinical findings of 49 cases which underwent LTO. Patients were divided into two groups according to age at operation (19 cases in group 1 aged ≥65 years and 30 cases in group 2 aged <65). Patients in a single group were regrouped into two subgroups according to preoperative Takakura stage (stage II + IIIA versus IIIB) to determine if the degree of correction varied in Takakura stage IIIB. RESULTS Significant changes in radiographic parameters were observed with no significant differences in the amounts of correction between groups 1 and 2. Comparison of Takakura stage II + IIIA in group 1 to that in group 2 and stage IIIB in group 1 to that in group 2 revealed no significant differences in the amounts of correction. CONCLUSION LTO could be indicated for patients over 65 years if patient selection was appropriate. LTO in patients over 65 years showed similar radiographic improvements to those in younger patients, and the correction was successfully maintained during the follow-up period. The correctional power of all radiographic parameters did not vary by preoperative Takakura stage. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, 170 Juhwa-rio, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea.
| | - Gyu Heon Lee
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, 170 Juhwa-rio, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea.
| | - Jin Soo Suh
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, 170 Juhwa-rio, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea.
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