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Li Y, Li J, Gan T, Gong H, Ma X, Yin S, Qin B, Wu S, Xie H, Zhang H. Focal Dome Osteotomy Combined with Ilizarov Technique for Treating Femoral Multiplanar Deformity. Orthop Surg 2024. [PMID: 39188009 DOI: 10.1111/os.14190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 08/28/2024] Open
Abstract
OBJECTIVE The management of femoral multiplanar deformity remains a great challenge for orthopaedic surgeons. The focal dome osteotomy (FDO) combined with Ilizarov technique is a theoretically ideal method for treating femoral multiplanar deformity, but the clinical evidence is limited. The aim of this study is to assess the clinical and radiological outcomes of this combined strategy for correcting femoral multiplanar deformities. METHODS A retrospective analysis was conducted to analyze 20 patients (29 limbs) with femoral multiplanar deformities treated by FDO combined with Ilizarov external fixation in our limb deformity center between 2017 and 2022. Preoperative and postoperative radiographical parameters were measured, including lateral proximal femoral angle (LPFA), mechanical lateral distal femoral angle (mLDFA), middle diaphysis angle (MDA), anatomic posterior distal femoral angle (aPDFA), mechanical axis deviation (MAD), and limb length discrepancy (LLD). Clinical assessments included a self-made questionnaire for exercise capacity score (ECS), visual analog scale (VAS), and the 36-Item Short-Form Health Survey (SF-36) score. RESULTS There were eight males and 12 females, with a mean age of 32.8 years (14-61 years). All patients completed follow-up with a mean follow-up duration of 41.5 (27-81) months. The mean EFT was 8.9 (1.4-20.2) months. At final follow-up, significantly improvement was noted regarding mean LLD (from 1.8 to 0.4 cm, p < 0.05), MDA (from 31.8° to 10.4°, p < 0.05), aPDFA (from 97.6° to 91.8°, p < 0.05), MAD (from 22.4 to 5.3 mm, p < 0.05), CORA on the true deformity plane (from 32.4° to 6.8°, p < 0.05). The mean VAS was decreased from 4.03 (2.0-6.0) preoperatively to 1.38 (0-3.0) at final follow-up (p < 0.05). The mean score of each item of SF-36 was significantly improved at final follow-up (p < 0.05). The mean ECS was improved from 8.2 (5-12) preoperatively to 11.4 (8-13) at final follow-up (p < 0.05). During the follow-up, one patient underwent pin exchange. One patient underwent internal fixation to replace the Ilizarov fixation 1.4 months after the first surgery. Residual LLD (>0.5 cm) was noted in four patients but without significant symptoms. No serious complications occurred. CONCLUSIONS The strategy of FDO combined with Ilizarov fixation could provide powerful ability and good flexibility for correcting femoral multiplanar deformities without significant complications.
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Affiliation(s)
- Yaxing Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jia Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Tingjiang Gan
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Heng Gong
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xikun Ma
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Shijiu Yin
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Boquan Qin
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Shizhou Wu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Huiqi Xie
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Anastasio AT, Lau B, Adams S. Ankle Osteoarthritis. J Am Acad Orthop Surg 2024; 32:738-746. [PMID: 38810230 DOI: 10.5435/jaaos-d-23-00743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
Ankle osteoarthritis (OA) is less common than knee and hip OA, and 75% to 80% of all presentations are posttraumatic in nature, resulting from either ligamentous or bony injury to the ankle. While the ankle joint cartilage demonstrates capacity for self-restoration, the ankle joint is sensitive to aberrancies in biomechanics and the inflammatory milieu after an injury is thought to contribute to the onset of posttraumatic ankle OA. Conservative care for ankle OA is currently centered on pain reduction, and derivatives that may delay the progression of ankle OA are the subject of ongoing investigation. Surgical management for end-stage ankle OA currently focuses on ankle arthrodesis and total ankle arthroplasty. Specific indication for one procedure over the other is the topic of much debate. While total ankle arthroplasty has become more frequently used with the advent of newer generation systems, ankle arthrodesis may still be favored in younger patients with high-demand occupations.
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Affiliation(s)
- Albert T Anastasio
- From the Duke University Department of Orthopaedic Surgery, Division of Sports Medicine, Durham, North Carolina
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Kim J, Lee WC. Deformity Correction: Do Osteochondral Lesion of the Talus and Tibia Change After Realignment Surgery? Foot Ankle Clin 2024; 29:333-342. [PMID: 38679443 DOI: 10.1016/j.fcl.2023.07.006] [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] [Indexed: 05/01/2024]
Abstract
Malalignment of the lower limb, distal tibia, foot, and hindfoot can all contribute to altered biomechanics in the ankle joint, resulting in increased focal pressure. The development of some osteochondral lesions of the ankle joint may share a similar pathophysiology, where eccentric loading to the talus or tibia within the ankle joint can lead to cartilage injury or adaptive changes. While the association between malalignment and the development of osteochondral lesions of the ankle joint may seem intuitive, the impact of realignment procedures on these lesions and patient symptoms remains a relatively underexplored topic in the literature. A comprehensive understanding of the potential role of realignment surgery in managing osteochondral lesions of the talus and tibia is crucial for advancing our knowledge of this challenging pathologic condition.
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Affiliation(s)
- Jaeyoung Kim
- Foot and Ankle Service, Hospital for Special Surgery, 532 East 72nd Street, New York, NY, USA
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, 45, Apgujeong-ro 30 gil, Gangnam-gu, Seoul 06022, Republic of Korea.
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Kim J, Yi Y, Lee WC. Improvement in Clinical and Radiographic Outcomes After Isolated Realignment Surgery in Patients With Large Cystic Osteochondral Lesion of the Talar Shoulder and Concurrent Malalignment. Orthop J Sports Med 2024; 12:23259671241237126. [PMID: 38617889 PMCID: PMC11010760 DOI: 10.1177/23259671241237126] [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: 08/08/2023] [Accepted: 09/07/2023] [Indexed: 04/16/2024] Open
Abstract
Background Malalignment has been suggested as a predisposing factor for the development of osteochondral lesions of the talus (OLTs). Purpose To evaluate the clinical and radiographic outcomes of realignment surgery in patients with a large cystic OLT of the talar shoulder and concurrent malalignment of the foot and ankle. Study Design Case series; Level of evidence, 4. Methods The authors reviewed consecutive patients with large cystic OLTs (diameter, >10 mm) of the talar shoulder and concurrent malalignment of the foot and ankle who underwent realignment surgery between September 2013 and April 2021. The type of realignment procedure was determined based on patient symptoms and findings on plain radiographs and weightbearing computed tomography. Clinical improvement was assessed using pre- and postoperative Foot Function Index (FFI) scores and the visual analog scale (VAS) for pain. The OLT location was categorized according to Raikin zone, and the OLT area and volume were measured and compared pre- and postoperatively. The comparative analysis was performed using the Wilcoxon signed-rank test. Results In total, 27 ankles in 27 patients (mean age, 34.4 ± 11.9 years) were included in the analysis. There were 25 patients with a medial lesion (zone 4 [n = 19], zone 7 [n = 5], and zone 1 [n = 1]), and 2 patients with a lateral lesion (zone 6). Despite OLT location, patients' symptoms varied; 15 (55.6%) patients reported both medial- and lateral-sided pain, 10 (37%) reported lateral-sided pain, and 2 (7%) reported medial-sided pain. Supramalleolar osteotomy was performed in 18 patients, while foot and hindfoot correction without supramalleolar osteotomy was performed in 9 patients. Postoperatively, both the median FFI (from 44.4 [interquartile range (IQR), 35.7-52.2] to 9.1 [IQR, 5.2-13.9]) and median VAS pain score (from 6 [IQR, 5-6] to 1 [IQR, 1-2]) improved significantly (P < .0001 for both), and the median lesion size (from 25.8 mm2 [IQR, 19.3-45.2 mm2] to 13.8 mm2 [IQR, 6.8-26.5 mm2]) and median volume (from 2226.8 mm3 [IQR, 1311-3104 mm3] to 1326.5 mm3 [IQR, 714-2100 mm3]) decreased significantly (P < .0001 for both). During the mean follow-up of 4.1 ± 2.1 years, no subsequent surgery for OLT was necessary. Conclusion The results suggest that realignment procedures can improve the symptoms and radiographic profile of OLTs in patients with large cystic OLTs of the talar shoulder and malalignment of the foot and ankle.
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Affiliation(s)
- Jaeyoung Kim
- Baylor University Medical Center, Dallas, Texas, USA
| | - Young Yi
- Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea
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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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Kim J, Rajan L, Henry J, Mizher R, Johnson AH, Demetracopoulos C, Ellis S, Deland J. Incidence and predictors of valgus tibiotalar tilt after progressive collapsing foot deformity reconstruction using subtalar fusion with concomitant procedures. Arch Orthop Trauma Surg 2023; 143:6087-6096. [PMID: 37160446 DOI: 10.1007/s00402-023-04906-x] [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: 01/25/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Development of valgus tibiotalar tilt is a significant complication after subtalar fusion for progressive collapsing foot deformity (PCFD) correction. However, its incidence and etiologic factors have not been extensively studied. The purpose of this study was to define the incidence of valgus tibiotalar tilt after subtalar fusion for PCFD reconstruction, and to determine predictors of this complication. METHODS This study included 59 patients who underwent PCFD reconstruction with subtalar fusion. Patients with tibiotalar tilt prior to surgery were excluded. On standard weightbearing radiographs, the talonavicular coverage angle, talo-1st metatarsal angle, calcaneal pitch, hindfoot moment arm (HMA), and medial distal tibial angle were measured. Weightbearing computed tomography (WBCT) was used to determine the presence of lateral bony impingement. A radiologist evaluated the superficial and deep deltoid ligaments using magnetic resonance imaging (MRI). Univariate regression analysis was used to identify the factors associated with development of postoperative valgus tibiotalar tilt, defined as tilt > 2 degrees. RESULTS Seventeen patients (28.8%) developed postoperative valgus tibiotalar tilt at a mean of 7.7 (range 2-31) months. Eight (47.1%) of these patients developed valgus tibiotalar tilt within 3 months. Univariate logistic regression demonstrated association between preoperative HMA and postoperative valgus tibiotalar tilt (odds ratio 1.06, P = 0.026), with a 6% increase in risk per millimeter of increased HMA. Deltoid ligament status and concomitant procedures on other joints did not correlate with postoperative valgus tilt. CONCLUSION Our findings indicate that surgeons should be cognizant of patients with a greater degree of preoperative hindfoot valgus and their propensity to develop a valgus ankle deformity. Additionally, our relatively high incidence of valgus tibiotalar tilt suggests that weightbearing ankle radiographs should be included in the initial and subsequent follow-up of PCFD patients with hindfoot valgus treated with subtalar fusion.
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Affiliation(s)
- Jaeyoung Kim
- Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA.
| | - Lavan Rajan
- Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA
| | - Jensen Henry
- Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA
| | - Rami Mizher
- Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA
| | - Anne Holly Johnson
- Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA
| | | | - Scott Ellis
- Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA
| | - Jonathan Deland
- Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA
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Mateen S, Siddiqui NA. The Role of Supramalleolar Osteotomies in Ankle Arthritis. Clin Podiatr Med Surg 2023; 40:769-781. [PMID: 37716751 DOI: 10.1016/j.cpm.2023.05.017] [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: 09/18/2023]
Abstract
The supramalleolar osteotomy (SMO) is a joint-preserving surgical procedure that allows realignment of the ankle joint in severe deformity secondary to arthritis. This osteotomy realigns the mechanical axis to provide better weight distribution through the ankle joint. With an aligned mechanical axis, the overloaded asymmetric ankle joint will shift toward the preserved joint area in a valgus or varus ankle joint. The SMO also can be used via a staged approach to correct severe deformity in an end-stage arthritic ankle before total ankle arthroplasty to optimize the implant's longevity and improve overall functional outcomes.
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Affiliation(s)
- Sara Mateen
- International Center of Limb Lengthening, Rubin Institute of Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Noman A Siddiqui
- International Center of Limb Lengthening, Rubin Institute of Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA; Division of Podiatry, Sinai and Northwest Hospital, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
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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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Haraguchi N, Asano K, Arimoto T, Niki H, Ota K, Ozeki T, Gibu M, Kanetake Y, Tsutaya A. Supramalleolar Lateral Opening-Wedge Osteotomy in Conjunction With Progressive Collapsing Foot Deformity Reconstruction for PCFD With Ankle Instability. Foot Ankle Int 2022; 43:1070-1083. [PMID: 35642666 DOI: 10.1177/10711007221093344] [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 Reconstruction of progressive collapsing foot deformity (PCFD) with ankle instability (PCFD class E) remains a substantial challenge to orthopaedic surgeons. We report the outcomes of PCFD class E treated by means of a relatively standard PCFD foot reconstruction approach with the addition of a supramalleolar lateral opening-wedge osteotomy. METHODS We conducted a retrospective study of 13 patients (15 ankles) who underwent this procedure for PCFD class E between 2010 and 2021. Mean follow-up time was 3.8 (range, 2-6.3) years. Clinical assessment was based on the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale as well as a Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Radiographic assessments, including identification of the mechanical ankle joint axis point and a modified valgus Takakura-Tanaka osteoarthritis grade, were recorded. RESULTS The mean JSSF score improved significantly from 45.2 preoperatively to 83.9 postoperatively (P < .001). SAFE-Q scores at the final follow-up were 70.1 for the pain and pain-related subscale, 75.4 for the physical functioning and daily living subscale, 83.0 for the social functioning subscale, 74.4 for the shoe-related subscale, and 78.1 for the general health and well-being subscale. Radiographic measurements showed improvement in the tibiotalar tilt angle (average improvement: 5.4 degrees); orientation of the talus joint line relative to the ground (average improvement: 14.0 degrees); anteroposterior talus-first metatarsal angle (average improvement: 11.2 degrees), talonavicular coverage angle (average improvement: 21.6 degrees), and lateral talus-first metatarsal angle (average improvement: 17.0 degrees). Postoperatively, the mechanical ankle joint axis point moved medially for all patients and into the medial half of the ankle joint for 7 patients. The modified osteoarthritis stage improved postoperatively in most cases. CONCLUSION In this select and relatively small group of patients who had a supramalleolar lateral opening-wedge osteotomy combined with PCFD reconstruction, we measured general improvement in JSSF scores and radiographic variables. Long-term durability of the procedure remains unknown. This procedure may be an option for preserving the ankle joint in treatment of PCFD class E with osteoarthritis of the ankle. LEVEL OF EVIDENCE Level IV, therapeutic.
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Affiliation(s)
- Naoki Haraguchi
- Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, Asahi-ku, Yokohama, Kanagawa, Japan
| | - Kota Asano
- Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, Asahi-ku, Yokohama, Kanagawa, Japan
| | - Tatsuya Arimoto
- Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, Asahi-ku, Yokohama, Kanagawa, Japan
| | - Hisateru Niki
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Koki Ota
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, Nakano-ku, Tokyo, Japan
| | - Takuma Ozeki
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, Nakano-ku, Tokyo, Japan
| | - Masaki Gibu
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, Nakano-ku, Tokyo, Japan
| | - Yoshihiko Kanetake
- Department of Radiology, Tokyo Metropolitan Police Hospital, Nakano-ku, Tokyo, Japan
| | - Atsushi Tsutaya
- Department of Radiology, Tokyo Metropolitan Police Hospital, Nakano-ku, Tokyo, Japan
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Stukenborg-Colsman C, Ettinger S, Claassen L, Daiwei Y, Plaass C. [Conversion osteotomy for arthrosis of the ankle joint (supramalleolar and inframalleolar)-What can be expected? : Critical review of the literature]. Unfallchirurg 2022; 125:189-195. [PMID: 35147709 DOI: 10.1007/s00113-022-01142-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
The aim of supramalleolar conversion osteotomy is to reduce the pain of the patient and stop or at least slow down joint degeneration. The indication for supramalleolar osteotomy is asymmetric osteoarthritis of the ankle joint with varus or valgus deformity. Good clinical results for arthritis can be achieved in the early or middle stages. Besides closing and opening wedge osteotomies dome osteotomy is sometimes indicated, especially for larger deformities. The preoperative preparation of individual patient-specific section blocks facilitates the intraoperative implementation and seems to increase the precision. Further studies are necessary to support this. The indications for additional procedures, such as fibular osteotomy are still being discussed. Inframalleolar osteotomy and soft tissue interventions are frequently necessary for balancing the foot.
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Affiliation(s)
- Christina Stukenborg-Colsman
- Department Fuß- und Sprunggelenkchirurgie, Orthopädische Klinik, DIAKOVERE Annastift, Medizinische Hochschule Hannover, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland.
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