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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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Spierenburg W, de Vries A, van der Wel H, Kraeima J, Dal M, van Raaij T. Mechanical Ankle Joint Axis Point on a Hip-to-Calcaneus Long Leg View Correlates Significantly With SPECT/CT Activation in Symptomatic Asymmetric Ankle Osteoarthritis. Foot Ankle Int 2024:10711007241263797. [PMID: 39095986 DOI: 10.1177/10711007241263797] [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: 08/04/2024]
Abstract
BACKGROUND Asymmetric joint load is the main cause of development of ankle osteoarthritis (OA). Realignment surgery aims to transfer ankle joint load from the degenerative area toward the uninvolved area. Determination of the optimal shift is still challenging. When the degenerative area is correlated to the ankle joint mechanical axis establishing an optimal target angle for corrective surgery may become more feasible. The primary aim of our study was to investigate if the area of ankle joint activation on single-photon emission computed tomography and conventional computed tomography (SPECT/CT) imaging correlates with the mechanical ankle joint axis point (MAJAP). METHODS In this cross-sectional study, patients 18 years or older with symptomatic asymmetric ankle OA and a hip-to-calcaneus long leg view with SPECT/CT of the affected ankle were eligible for inclusion. Primary outcome was MAJAP divided into 3 alignment categories (medial shift, neutral, lateral shift). SPECT/CT activation was determined in 8 different areas of the ankle joint. A Spearman rho correlation coefficient was calculated to investigate the relationship between the alignment categories and SPECT/CT activation in the 8 areas. RESULTS Forty-nine patients (mean age 58.8 [SD 10.0] years) with 52 ankles with moderate to severe asymmetric OA were included. A significantly (Spearman rho -0.379 [P = .006] and Spearman rho -0.279 [P = .045]) higher proportion of ankles with radioisotope uptake in the anteromedial ankle joint areas (zones 1 and 5) was seen in the medial shift category. A significantly (Spearman rho .312 (P = .025)) higher proportion of ankles with radioisotope uptake in the anterolateral ankle joint area (zone 8) was seen in the lateral shift category. CONCLUSION We found in this patient group that the area of SPECT/CT uptake in asymmetric ankle OA was associated to MAJAP measured on hip-to-calcaneus weightbearing views, although the strength of the correlation is weak to moderate. Consequently, nonweightbearing metabolic SPECT/CT radiotracer uptake has the potential to help determine the area to unload in ankle joint-preserving alignment surgery.
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Affiliation(s)
- Willemijn Spierenburg
- Department of Orthopedic Surgery, Martini Hospital Groningen, Groningen, the Netherlands
| | - Astrid de Vries
- Department of Orthopedic Surgery, Martini Hospital Groningen, Groningen, the Netherlands
| | - Hylke van der Wel
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Muhammed Dal
- Department of Radiology, Martini Hospital Groningen, Groningen, the Netherlands
| | - Tom van Raaij
- Department of Orthopedic Surgery, Martini Hospital Groningen, Groningen, the Netherlands
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Cao ZL, Wang CH, Ding XH, Wang ZD, Dong QY. Outcomes of ankle arthrodesis in adult patients with ankle osteoarthritis in Kashin-Beck disease. INTERNATIONAL ORTHOPAEDICS 2024; 48:2145-2151. [PMID: 38679689 DOI: 10.1007/s00264-024-06195-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/16/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE We retrospectively evaluated the characteristics of these patients and the effectiveness of ankle arthrodesis in the treatment of ankle arthritis caused by Kashin-Beck disease (KBD). METHODS A retrospective study of KBD patients with ankle osteoarthritis who underwent ankle arthrodesis between December 2012 and January 2022 was performed. A total of 46 patients were included. The general characteristics, clinical manifestations and imaging features of the patients were recorded and summarized. measured using the VAS score, and ankle function was assessed by the AOFAS ankle-hindfoot score. RESULTS Multiple subchondral cystic changes were found in 42(91.3%) patients. The VAS scores for both resting and weight-bearing conditions were 6.28 ± 1.30 vs. 2.09 ± 1.12 (P < .001) and 6.87 ± 1.01 vs. 2.17 ± 0.98 (P < .001), respectively. The AOFAS scores were 59.17 ± 5.50 and 88.39 ± 1.42, respectively (P < .001). CONCLUSIONS The subchondral multiple cystic transformation of the ankle KBD has a certain suggestive role.Arthrodesis is an effective method to reduce ankle pain and improve ankle function in KBD patients with ankle osteoarthritis.
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Affiliation(s)
- Zhen Lu Cao
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China
| | - Chen Han Wang
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China
| | - Xiao Heng Ding
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China
| | - Zheng Dan Wang
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China
| | - Quan Yu Dong
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China.
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Lee JM, Lee SJ, Park CH. Pressure change at ankle joint in supramalleolar osteotomy with or without fibular osteotomy according to different types of varus ankle. J Orthop Res 2024; 42:1771-1779. [PMID: 38440854 DOI: 10.1002/jor.25817] [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: 02/23/2023] [Revised: 12/30/2023] [Accepted: 01/19/2024] [Indexed: 03/06/2024]
Abstract
The need for additional fibular osteotomy (FO) when performing supramalleolar osteotomy (SMO) in the varus ankle arthritis (VAA) is controversial. Some cadaveric studies have been performed to prove this; however, it is difficult to implement deformities including talar tilting and translation in cadavers. In this study, we created a model of VAA with the tilting and translation using three-dimensional (3-D) finite element (FE) analysis and analyzed the results of SMO with or without FO depending on the types of VAA. The validated normal foot and ankle 3-D FE model was constructed including the ankle cartilages of the talar dome and tibia plafond. The VAA models were determined and reconstructed by following the classification of VAA, VAA with medial translation for stage 3a, VAA with varus tilting (7.5°) for stage 3b. The postoperative SMO models (SMO with and without FO) were reconstructed by corresponding to each VAA models. The FE analysis conditions were commonly applied. The boundary condition of ankle joint was defined as "sliding condition" and applied 0.002 friction coefficient to realize lubricative property. Loading condition was assumed as a two-leg standing position and half of the subject body weight (325 N) was loaded on center of ground to vertical direction. Contact pressure changes were predicted at the medial ankle cartilage. As a result, in VAA with medial translation, isolated SMO may provide sufficient pressure reduction at the medial ankle joint. However, in VAA with varus tilting, SMO combined with FO could appropriately relieve concentrated pressure at the medial ankle joint.
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Affiliation(s)
- Jung-Min Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Republic of Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Republic of Korea
| | - Chul Hyun Park
- Department of Orthopedic Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Eatough ZJ, Peterson AC, Lisonbee RJ, Miyamoto T, Tanaka Y, Saltzman CL, Krähenbühl N, Lenz AL. Static posture weightbearing joint angle differences in patients with varus ankle osteoarthritis. Gait Posture 2024; 112:33-39. [PMID: 38729081 PMCID: PMC11234790 DOI: 10.1016/j.gaitpost.2024.05.003] [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: 01/29/2024] [Revised: 04/19/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Advanced varus ankle osteoarthritis is a debilitating disease that can present with limited physical function, severe pain, and diminished quality of life. Weightbearing computed tomography enables submillimeter 3-dimensional visualization, computational analyses, and enhanced diagnoses in reporting complex degenerative changes more accurately. RESEARCH QUESTION This study set to compare static posture weightbearing joint angle differences in healthy and varus ankle osteoarthritis patients (compensated and non-compensated). METHODS Our retrospective assessment included 70 individuals, 44 of whom were diagnosed with advanced varus ankle osteoarthritis, and the remaining 26 were healthy participants to serve as controls. An automatic anatomic coordinate system was applied to each patient's 3-dimensional talus and calcaneus bone reconstructions from weightbearing computed tomography scans. Subtalar and midtarsal joint angles were calculated using Euler angles. RESULTS We report statistical differences between the healthy group and both advanced varus osteoarthritis groups for midtarsal inversion/eversion. Specifically, both osteoarthritis groups' midtarsal joints were more inverted and plantarflexed as compared to healthy participants. Compensated and non-compensated subtalar joints were statistically different with respect to inversion/eversion. Non-compensated ankles exhibited a similar mean to healthy ankles who were both less inverted than compensated ankles. SIGNIFICANCE Our study helps physicians to better understand underlying mechanisms of peritalar compensation in varus ankle osteoarthritis. Patients featuring hindfoot compensation on average had a greater subtalar joint angle indicating greater inversion than healthy and non-compensated patients.
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Affiliation(s)
- Zachary J Eatough
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Andrew C Peterson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Rich J Lisonbee
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Takuma Miyamoto
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara 634-8521, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara 634-8521, Japan
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Nicola Krähenbühl
- Department of Orthopaedics, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
| | - Amy L Lenz
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Biomedical Engineering, University of Utah, 36 S Wasatch Dr, Salt Lake City, UT 84112, USA.
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Nishimura A, Senga Y, Fujikawa Y, Takegami N, Akeda K, Ogura T, Sudo A. Prevalence and risk factors of ankle osteoarthritis in a population-based study. Foot Ankle Surg 2024; 30:389-393. [PMID: 38453588 DOI: 10.1016/j.fas.2024.02.009] [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: 10/30/2023] [Revised: 01/14/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND This study aimed to investigate the prevalence of radiographic ankle osteoarthritis (AOA) in Japan and identify its risk factors. METHODS The analysis included data from the population-based cohort study, radiographs of the knees and ankles, ultrasonography of the ankle to examine chronic ankle instability (CAI), and questionnaires on ankle pain, job history, height, and body weight. A total of 597 individuals aged > 50 years were included in the study. The risk factors for AOA were calculated using multivariate logistic regression analysis. RESULTS The study revealed a 13.9% prevalence of radiographic AOA among the participants, with 1.2% reporting painful AOA. Female sex, aging, history of ankle fractures, and CAI were identified as the risk factors associated with AOA. CONCLUSIONS This cross-sectional study highlights the significant prevalence of radiographic AOA in a rural Japanese population, emphasizing the importance of considering ankle fractures and CAI as potential risk factors for AOA development. LEVELS OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Akinobu Nishimura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan; Departments of Orthopaedic and Sports Medicine, Mie University Graduate School of Medicine, Mie, Japan.
| | - Yoshiyuki Senga
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Yuki Fujikawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Norihiko Takegami
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Toru Ogura
- Clinical Research Support Center, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
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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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Yang HY, Kang JK, Kim JW, Yoon TW, Seon JK. Preoperative Hindfoot Alignment and Outcomes After High Tibial Osteotomy for Varus Knee Osteoarthritis: We Walk on Our Heel, Not Our Ankle. J Bone Joint Surg Am 2024; 106:896-905. [PMID: 38386715 DOI: 10.2106/jbjs.23.00720] [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] [Indexed: 02/24/2024]
Abstract
UPDATE This article was updated on May 15, 2024 because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 898, in the section entitled "Materials and Methods," the sentence that had read "The WBL ratio of the knee joint was defined as the point where the GA or MA passed through the width of the tibia and intersected a line from the center of the femoral head to the center of the calcaneus (for the GA) or talus (for the MA), with the medial edge defined as 0% and the lateral edge as 100%." now reads "The WBL ratio of the knee joint was defined as the point where the GA or MA passed through the width of the tibia and intersected a line from the center of the femoral head to the lowest point of the calcaneus (for the GA) or the center of the talus (for the MA), with the medial edge defined as 0% and the lateral edge as 100%." Likewise, in the legend for Figure 3 on page 899, the sentence that had read "Depiction of the ground mechanical axis (GA), defined as the line (represented by the solid red line) from the center of the femoral head to the ground reaction point at the center of the calcaneus, passing lateral to the traditional mechanical axis (MA; represented by the dashed red line)." now reads "Depiction of the ground mechanical axis (GA), defined as the line (represented by the solid red line) from the center of the femoral head to the ground reaction point at the lowest point of the calcaneus, passing lateral to the traditional mechanical axis (MA; represented by the dashed red line)." Finally, on page 903, "HKA" was changed to "HKA angle" in Table III. BACKGROUND The hip-to-calcaneus axis, previously known as the ground mechanical axis (GA), ideally passes through the center of the knee joint in the native knee. The aim of this study was to elucidate, with use of hip-to-calcaneus radiographs, changes in knee and hindfoot alignment and changes in outcomes following high tibial osteotomy (HTO). METHODS We reviewed the records for 128 patients who underwent HTO between 2018 and 2020. Patients were stratified into 2 groups, a hindfoot valgus group (n = 94) and a hindfoot varus group (n = 34), on the basis of their preoperative hindfoot alignment. The hindfoot alignment was evaluated with use of the hindfoot alignment angle (HAA). To evaluate lower-limb alignment, full-length standing posteroanterior hip-to-calcaneus radiographs were utilized to measure 4 radiographic parameters preoperatively and 2 years postoperatively: the hip-knee-ankle (HKA) angle, hip-knee-calcaneus (HKC) angle, and the weight-bearing line (WBL) ratios of the mechanical axis (MA) and GA. RESULTS The mean HAA improved significantly from 5.1° valgus preoperatively to 1.9° valgus postoperatively in the hindfoot valgus group (p < 0.001). In contrast, in the hindfoot varus group, the HAA showed no meaningful improvement in the coronal alignment of the hindfoot following HTO (p = 0.236). The postoperative mean HKC angle in the hindfoot varus group was 2° more varus than that in the hindfoot valgus group (1.0° versus 3.0°; p = 0.001), and the GA in the hindfoot varus group passed across the knee 8.0% more medially than that in the hindfoot valgus group (55% versus 63% from the most medial to the most lateral part of the tibial plateau). The hindfoot varus group had worse postoperative clinical outcomes than the hindfoot valgus group in terms of the mean Knee injury and Osteoarthritis Outcome Score for pain and American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score. CONCLUSIONS Although our findings did not provide sufficient evidence to establish clinically relevant differences between the groups, they indicated that the group with a preoperative fixed hindfoot varus deformity had a higher rate of undercorrection and worse clinical outcomes, especially pain, following HTO. Therefore, modification of the procedure to shift the GA more laterally may be required for these patients. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hong Yeol Yang
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, College of Medicine, Chonnam National University, Seoyang, Republic of Korea
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Kikuchi N, Kanamori A, Kadone H, Okuno K, Hyodo K, Yamazaki M. Varus knee osteoarthritis with ankle osteoarthritis demonstrates greater hindfoot inversion and larger ankle inversion loading during gait following total knee arthroplasty compared to varus knee osteoarthritis alone. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38738824 DOI: 10.1002/ksa.12249] [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: 03/13/2024] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Although patients with varus knee osteoarthritis (KOA) and concurrent ankle osteoarthritis (AOA) may experience increased ankle joint pain after total knee arthroplasty (TKA), the underlying mechanism remains unclear. This study aimed to investigate the effects of concurrent AOA on ankle and hindfoot alignment, frontal plane ankle and hindfoot biomechanics during gait following TKA and the clinical outcomes. METHODS Twenty-four patients with varus KOA who underwent TKA were included in this retrospective cohort study. Patients were categorized into two groups: with and without AOA. Radiographic evaluations of lower-limb, ankle and hindfoot alignment, and knee and ankle clinical outcomes were conducted preoperatively and 6 months postoperatively. In addition, gait analyses were performed to investigate knee, ankle and hindfoot kinematics and kinetics. Each data was compared between patients with and without AOA. RESULTS Concomitant AOA was found in eight ankles. The AOA group exhibited greater postoperative hindfoot varus and increased postoperative ankle pain than the non-AOA group. Gait analysis showed no significant differences in knee varus alignment or tibial tilt after TKA between the groups. However, the AOA group demonstrated significantly greater hindfoot inversion and larger ankle inversion loading. CONCLUSION One third of patients who underwent TKA had concurrent AOA associated with hindfoot varus. Despite achieving proper coronal knee alignment postoperatively, these patients experienced greater hindfoot and ankle joint inversion load during gait. Surgeons should consider the inability to evert the hindfoot and the possibility of increased ankle joint pain when planning and performing TKA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Naoya Kikuchi
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akihiro Kanamori
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideki Kadone
- Center for Cybernics Research, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kosuke Okuno
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kojiro Hyodo
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Noguchi T, Hirao M, Okamura G, Etani Y, Ebina K, Tsuboi H, Goshima A, Miyama A, Takahi K, Takami K, Tsuji S, Okada S, Hashimoto J. Stabilizing effect of total ankle arthroplasty by distal translation and lateralization of talus in varus ankle deformity. Musculoskelet Surg 2024:10.1007/s12306-024-00820-6. [PMID: 38705948 DOI: 10.1007/s12306-024-00820-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/23/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND In end-stage arthritis indicated for total ankle arthroplasty (TAA), full-thickness cartilage damage, subchondral bone defect/shaving, and fluttering of the talar dome occur, shortening the distance between the tibial and talar insertions of ligaments and leading to laxity of ligaments surrounding the ankle joint. Under such conditions, medial ligaments (including the deltoid ligament) would not be expected to function properly. To stabilize the ankle joint during the stance phase, medial ligament function under tension is important. This study therefore examined whether TAA contributes to lengthening of the medial tibio-talar joint as evaluated radiographically, as a preferable method for achieving tensile effects on medial ligaments. MATERIALS AND METHODS Twenty-four feet with end-stage varus deformity of the ankle joint that underwent TAA were retrospectively investigated, excluding cases with any malleolar osteotomy or fracture. Distance between proximal and distal insertions of medial ligaments, lateralization of the talus, and talar tilt angle under valgus/varus stress condition were evaluated pre- and postoperatively. RESULTS Distance between proximal and distal insertions of medial ligaments was significantly elongated after TAA. At the same time, the talus showed significant lateralization. Furthermore, talar tilt under valgus/varus stress conditions was also significantly reduced after TAA. CONCLUSION TAA affects distal translation and lateralization of the talus in cases of varus ankle deformity. These effects might contribute to re-providing tensile force on lax medial ligaments, improving ligament function.
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Affiliation(s)
- T Noguchi
- Department of Orthopaedic Surgery, Osaka Minami Medical Center, National Hospital Organization, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - M Hirao
- Department of Orthopaedic Surgery, Osaka Minami Medical Center, National Hospital Organization, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan.
| | - G Okamura
- Department of Orthopaedic Surgery, Osaka Minami Medical Center, National Hospital Organization, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - Y Etani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - K Ebina
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - H Tsuboi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - A Goshima
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - A Miyama
- Department of Orthopaedic Surgery, Osaka-Toneyama Medical Center, National Hospital Organization, Osaka, Japan
| | - K Takahi
- Department of Orthopaedic Surgery, Osaka-Toneyama Medical Center, National Hospital Organization, Osaka, Japan
| | - K Takami
- Department of Orthopaedic Surgery, Nippon Life Hospital, Osaka, Japan
| | - S Tsuji
- Department of Orthopaedic Surgery, Nippon Life Hospital, Osaka, Japan
| | - S Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - J Hashimoto
- Department of Orthopaedic Surgery, Osaka Minami Medical Center, National Hospital Organization, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
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Kim J, Palmar J, Demetracopoulos C, Ellis S, Deland J. Radiographic Analysis of Valgus Ankle Deformity With or Without Medial Longitudinal Arch Collapse. Foot Ankle Int 2024; 45:517-525. [PMID: 38445609 DOI: 10.1177/10711007241231230] [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: 03/07/2024]
Abstract
BACKGROUND Establishing a surgical plan for ankle deformities necessitates a comprehensive understanding of the deforming forces involved, and the morphology of the ankle deformity plays an important role as well. Valgus tibiotalar tilt development has mostly been described in patients with a low medial longitudinal arch, as seen in progressive collapsing foot deformity (PCFD). However, some valgus ankles demonstrate no radiographic evidence of a collapsed medial arch. This study aims to investigate whether there are differences in the radiographic morphology of valgus ankle deformities between patients with and without a low medial longitudinal arch to explore if they have different etiologies. METHODS We retrospectively reviewed patients who underwent surgical treatment for asymmetric valgus ankle deformity at our institution between 2017 and 2021. Patients with a valgus tibiotalar tilt (TT) greater than 4 degrees and Meary angle greater than 30 degrees (mean: 38.9) were included in the PCFD group (n = 29). The non-PCFD group (n = 24) with TT greater than 4 degrees and Meary angle less than 4 degrees (mean: 0.3) was also established. In the weightbearing ankle anteroposterior view, the TT and medial distal tibial angle were measured. Additionally, to assess the mediolateral position of the talus, the talar center migration (TCM) and lateral talar dome-plafond distance (LTD-P) ratio in the coronal plane were measured. In weightbearing computed tomography (WBCT), the degree of axial plane talocalcaneal subluxation and the prevalence of sinus tarsi bony impingement were assessed. Intergroup comparison was conducted. RESULTS Both groups demonstrated a similar degree of TT, with a mean of 11.6 degrees in the PCFD group and 13.7 degrees in the non-PCFD group (P = .2330). However, the PCFD group showed a significantly greater TCM and LTD-P ratio compared with those of the non-PCFD group (P < .0001), indicating that PCFD patients have a more medially translated talus in ankle anteroposterior radiographs. WBCT showed that the PCFD group on average had 18 degrees greater axial plane talocalcaneal subluxation (P < .0001) and 52% higher prevalence of sinus tarsi bony impingement (P = .0002) compared with the non-PCFD group. CONCLUSION This study suggests that valgus ankles may exhibit different radiographic morphologies depending on the status of the longitudinal arch. Valgus ankles in PCFD patients tend to have a more medially translated talus. This finding may suggest the presence of different deforming forces between the 2 groups and may indicate the need for different treatment strategies to address talar tilt. LEVEL OF EVIDENCE Level III, case-control.
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Affiliation(s)
- Jaeyoung Kim
- Baylor University Medical Center, Dallas, TX, USA
- Hospital for Special Surgery, New York, NY, USA
| | | | | | - Scott Ellis
- Hospital for Special Surgery, New York, NY, USA
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12
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Sakurai S, Nakasa T, Ikuta Y, Kawabata S, Moriwaki D, Ishibashi S, Silan AA, Adachi N. The Relationship Between Calcaneofibular Ligament Injury and Ankle Osteoarthritis Progression: A Comprehensive Analysis of Stress Distribution and Osteophyte Formation in the Subtalar Joint. Foot Ankle Int 2024:10711007241245363. [PMID: 38647205 DOI: 10.1177/10711007241245363] [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: 04/25/2024]
Abstract
BACKGROUND Ankle osteoarthritis (OA) mainly arises from trauma, particularly lateral ligament injuries. Among lateral ligament injuries, ankles with calcaneofibular ligament (CFL) injuries exhibit increased instability and can be a risk factor ankle OA progression. However, the relationship between CFL injury and OA progression remains unclear. Therefore, this study aims to assess the relationship between CFL injuries and ankle OA by investigating stress changes and osteophyte formation in subtalar joint. METHODS We retrospectively reviewed the magnetic resonance imaging (MRI) and plain radiographic evaluations of 100 ankles of 91 patients presenting with chronic ankle instability (CAI), ankle OA, or other ankle conditions. The association between CFL injuries on the oblique view of MRI and the severity of ankle OA (based on Takakura-Tanaka classification) was statistically evaluated. Additionally, 71 ankles were further subjected to CT evaluation to determine the association between the CFL injuries and the Hounsfield unit (HU) ratios of the subtalar joint and medial gutter, and the correlation between the subtalar HU ratios and osteophyte severity were statistically evaluated. RESULTS CFL injury was observed in 35.9% (14/39) of patients with stage 0, 42.9% (9/21) with stage 1, 50.0% (10/20) with stage 2, 100% (9/9) with stage 3a, and 90.9% (10/11) with stage 3b. CFL-injured ankles exhibited higher HU ratios in the medial gutter and lower ratios in the medial posterior subtalar joint compared to uninjured ankles. A negative correlation was observed between medial osteophyte severity and the medial subtalar joint HU ratio. CONCLUSION Our findings suggest that CFL injuries are common in severe ankle OA impairing the compensatory function of the subtalar joint through abnormal stress distribution and osteophyte formation. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Satoru Sakurai
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shingo Kawabata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Dan Moriwaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Saori Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Asyumaredha Asril Silan
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Orthopaedic and Traumatology Division, Muhammad Djamil Central Hospital, Padang, Indonesia
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Zendeli F, Pflüger P, Viehöfer AF, Hodel S, Wirth SH, Farshad M, Weigelt L. A Smaller Tibiotalar Sector Is a Risk Factor for Recurrent Anterolateral Ankle Instability after a Modified Broström-Gould Procedure. Foot Ankle Int 2024; 45:338-347. [PMID: 38390712 PMCID: PMC11192177 DOI: 10.1177/10711007241227925] [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: 02/24/2024]
Abstract
BACKGROUND Several demographic and clinical risk factors for recurrent ankle instability have been described. The main objective of this study was to investigate the potential influence of morphologic characteristics of the ankle joint on the occurrence of recurrent instability and the functional outcomes following a modified Broström-Gould procedure for chronic lateral ankle instability. METHODS Fifty-eight ankles from 58 patients (28 males and 30 females) undergoing a modified Broström-Gould procedure for chronic lateral ankle instability between January 2014 and July 2021 were available for clinical and radiological evaluation. Based on the preoperative radiographs, the following radiographic parameters were measured: talar width (TW), tibial anterior surface (TAS) angle, talar height (TH), talar radius (TR), tibiotalar sector (TTS), and tibial lateral surface (TLS) angle. The history of recurrent ankle instability and the functional outcome using the Karlsson Score were assessed after a minimum follow-up of 2 years. RESULTS Recurrent ankle instability was reported in 14 patients (24%). The TTS was significantly lower in patients with recurrent ankle instability (69.8 degrees vs 79.3 degrees) (P < .00001). The multivariate logistic regression model confirmed the TTS as an independent risk factor for recurrent ankle instability (OR = 1.64) (P = .003). The receiver operating characteristic curve analysis revealed that patients with a TTS lower than 72 degrees (=low-TTS group) had an 82-fold increased risk for recurrent ankle instability (P = .001). The low-TTS group showed a significantly higher rate of recurrent instability (58% vs 8%; P = .0001) and a significantly lower Karlsson score (65 points vs 85 points; P < .00001). CONCLUSION A smaller TTS was found to be an independent risk factor for recurrent ankle instability and led to poorer functional outcomes after a modified Broström-Gould procedure. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Flamur Zendeli
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick Pflüger
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Arnd F. Viehöfer
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sandro Hodel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stephan H. Wirth
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lizzy Weigelt
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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14
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Rammelt S, Walther EJ. Joint-Preserving Osteotomy of the Lateral Tibial Plafond for Posttraumatic Osteonecrosis: A Prospective Cohort Study. Foot Ankle Int 2024; 45:328-337. [PMID: 38389195 DOI: 10.1177/10711007241227928] [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: 02/24/2024]
Abstract
BACKGROUND Posttraumatic osteonecrosis (ON) of the lateral distal tibia is a rare but severe complication of malleolar fractures. Treatment options include ankle fusion, arthroplasty, osteotomy, and drilling but clinical data on outcomes are limited to single case reports. The aim of this study was to prospectively evaluate the outcome following joint-preserving reconstruction. METHODS Over a 10-year period, 10 patients (8 females and 2 males, average age 36 years; range, 27-68 years) with posttraumatic ON were treated with intra-articular osteotomy of the distal tibia and bone grafting. All patients initially sustained a closed pronation injury, 7 with initial tibiotalar subluxation. Chronic syndesmotic instability following initial treatment was present in 4 patients and 5 were smokers. All patients were followed for a median of 68 (range, 12-103) months, 7 returned in person for clinical and radiographic follow-up. RESULTS No immediate postoperative complications were seen. Secondary ankle fusion was necessary in 1 case (10%) because of progressive osteoarthritis. At the time of follow-up, anterior ankle arthritis leading to impingement and requiring cheilectomy was noted in 4 cases, partial graft necrosis, and secondary syndesmotic instability requiring revision surgery was seen in 1 case each. Compared with the preoperative values, significant improvement in the Olerud-Molander Ankle Score (P = .012), EuroQuol-5 Score (P = .008), and Foot Function Index (FFI-D pain, P = .028; FFI-D restriction, P = .038) was seen. Average range of motion at the ankle was 45 degrees. CONCLUSION In our limited series of patients with posttraumatic ON of the lateral distal tibia, we found that joint-preserving reconstruction using an intra-articular distal tibial osteotomy with autologous bone grafting usually provided significant functional improvement and pain relief. In our cohort secondary fusions by a median 5.5-year follow-up were rare, but secondary, joint-sparing surgeries were common. LEVEL OF EVIDENCE Level III, prospective study.
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Affiliation(s)
- Stefan Rammelt
- University Center of Orthopaedics, Trauma and Plastic Surgery, Dresden, Germany
- University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - Eric Jörg Walther
- University Center of Orthopaedics, Trauma and Plastic Surgery, Dresden, Germany
- University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
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15
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Zielli SO, Mazzotti A, Artioli E, Marcolli D, Arceri A, Bonelli S, Faldini C. Indications, Associated Procedures, and Results of Ankle Plafond-Plasty for Varus Ankle Osteoarthritis: A Systematic Review and Meta-Analysis. Foot Ankle Spec 2024:19386400241236321. [PMID: 38504416 DOI: 10.1177/19386400241236321] [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: 03/21/2024]
Abstract
BACKGROUNDS Plafond-plasty is a joint-preserving procedure to treat varus ankle osteoarthritis (OA) with asymmetrical joint involvement. The aim of this systematic review and meta-analysis was to evaluate indications, different surgical techniques, associated procedures, and results of plafond-plasty in varus ankle OA and to analyze the level of evidence (LOE) and quality of evidence (QOE) of the included studies. METHODS A systematic review of the literature was performed using MEDLINE, Embase, and Cochrane. RESULTS Five studies evaluating 99 ankles were included. A non-rigid varus ankle deformity and an ankle OA Takakura stage 3b or less were the most recommended pre-operative indications. Meta-analysis showed a significant post-operative improvement in clinical and radiological parameters. Many associated surgical procedures have been reported, the most frequent being medial additional supramalleolar osteotomy and lateral ankle ligament reconstruction. The level of evidence and methodological quality assessment of the included studies showed an overall low quality. CONCLUSION Plafond-plasty seems to be a promising surgical option when managing varus ankle OA with asymmetrical joint involvement, extending the indications for joint sparing surgery. Additional associated procedures should be carefully evaluated case-by-case. LEVELS OF EVIDENCE IV.
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Affiliation(s)
- Simone Ottavio Zielli
- First Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antonio Mazzotti
- First Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elena Artioli
- First Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Daniele Marcolli
- UOC Week Surgery, Azienda Socio-Sanitaria territoriale, centro specialistico ortopedico traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Alberto Arceri
- First Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simone Bonelli
- First Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- First Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
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16
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Takahashi K, Teramoto A, Yamaguchi S, Amaha K, Saiga K, Noguchi K, Watanabe K. Characteristics of Nonunion After Arthroscopic Ankle Arthrodesis: A Multicenter Retrospective Cohort Study. J Foot Ankle Surg 2024; 63:123-126. [PMID: 38043597 DOI: 10.1053/j.jfas.2023.11.009] [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: 06/05/2023] [Revised: 10/01/2023] [Accepted: 11/26/2023] [Indexed: 12/05/2023]
Abstract
Nonunion is a major complication of arthroscopic ankle arthrodesis. However, the characteristics and risk factors of nonunion are not well understood. This retrospective multicenter observational study aimed to clarify the characteristics of nonunion after arthroscopic ankle arthrodesis. We included 154 patients who underwent arthroscopic ankle arthrodesis at any 1 of 5 institutions. Patients were divided into 2 groups: union and nonunion, and the groups were compared. Age, sex, body mass index, diabetes, smoking, corticosteroid use, diagnosis, treatment information, treatment protocol, radiographic evaluation, and patient-reported outcomes were recorded and analyzed. On radiographs, bony union was observed in 142 ankles (91.0%) but not in 12 ankles (9.0%). Postoperative radiographic tibial bony gap (mm) was significantly larger in the nonunion group (medial = 1.98, center = 1.65, anterior = 2.21, middle = 1.72, posterior = 3.01) than in the union group (medial = 1.35, center = 1.13, anterior = 1.28, middle = 1.03, posterior = 2.03). Furthermore, the visual analog score (VAS) of pain and pain-related self-administered foot evaluation questionnaire (SAFE-Q) subscale score significantly worsened in the nonunion group (VAS = 3.83, SAFE-Q subscale score = 69.8) compared to that in the union group (VAS = 1.35, SAFE-Q subscale score = 76.6). A larger radiographic tibiotalar bony gap was observed in the nonunion group. Other measurement outcomes were not associated with nonunion. Additionally, patient-reported outcomes markedly worsened in the nonunion group.
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Affiliation(s)
- Katsunori Takahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
| | - Satoshi Yamaguchi
- Graduate School of Global and Transdisciplinary Studies, Chiba University, Chiba, Japan; Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Kentaro Amaha
- Department of Orthopedic Surgery, St Luke's International Hospital, Akashicho, Chuo-ku, Tokyo, Japan
| | - Kenta Saiga
- Department of Sports Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Koji Noguchi
- Japan Community Health care Organization (JCHO) Kurume General Hospital, Kurume, Fukuoka, Japan
| | - Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Hokkaido, Japan
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17
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Lee SW, Yon CJ, Kim JH, Lee JM, Lee JH, Heo YR. Comparison of the Usefulness of Computer-Assisted Three-Dimensional Analysis and Weight-Bearing Radiographs in Ankle Osteoarthritis. Clin Orthop Surg 2024; 16:141-148. [PMID: 38304214 PMCID: PMC10825248 DOI: 10.4055/cios23221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 02/03/2024] Open
Abstract
Background To evaluate the degree of deformation in patients with ankle osteoarthritis (OA), it is essential to measure the three-dimensional (3D), in other words, stereoscopic alignment of the ankle, subtalar, and foot arches. Generally, measurement of radiological parameters use two-dimensional (2D) anteroposterior and lateral radiographs in a weight-bearing state; however, computer-aided 3D analysis (Disior) using weight-bearing cone-beam computed tomography (CBCT) has recently been introduced. Methods In this study, we compared the 2D human radiographic method with a stereoscopic image in patients with ankle arthritis. We enrolled 57 patients diagnosed with OA (28 left and 29 right) and obtained both standing radiographs and weight-bearing CBCT. Patients were divided by the Takakura stage. The interclass correlation coefficient (ICC) for each result was confirmed. Results On the ICC between 2D radiographs and 3D analysis, the tibiotalar surface angle and lateral talo-1st metatarsal angle showed a good ICC grade (> 0.6), while other parameters did not have significant ICC results. Three-dimension was superior to radiographs in terms of statistical significance. Conclusions We demonstrated that 2D and stereoscopic images are useful for the diagnosis of OA. Our study also confirmed that the radiographic features affected by ankle OA varied. However, according to the results, the typical radiography is not sufficient to diagnose and determine a treatment plan for ankle OA. Therefore, the method of using 3D images should be considered.
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Affiliation(s)
- Si-Wook Lee
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Chang-Jin Yon
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jae-Ho Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jung-Min Lee
- Industry-Academic Cooperation Foundation, Keimyung University, Daegu, Korea
| | - Jae-Ho Lee
- Department of Anatomy, Keimyung University College of Medicine, Daegu, Korea
| | - Yu-Ran Heo
- Department of Anatomy, Keimyung University College of Medicine, Daegu, Korea
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18
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Sakai T, Fujii M, Kitamura K, Tanaka H, Mawatari M. Biomechanical Effect of Distal Tibial Oblique Osteotomy: A Preliminary Finite-Element Analysis. Cureus 2024; 16:e53803. [PMID: 38465079 PMCID: PMC10924635 DOI: 10.7759/cureus.53803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The biomechanical effect of distal tibial oblique osteotomy (DTOO) on osteoarthritic ankles has not been investigated. Using finite element (FE) models, we aimed to elucidate the effect of DTOO on the ankle contact pressure (CP) distribution. METHODS This study included two patients with ankle osteoarthritis who underwent DTOO and one asymptomatic control. Patient-specific FE models were reconstructed by matching standing radiographs with supine computed tomography scans. The joint contact area (CA) and maximum CP on the articular surface of the talus were calculated before and after DTOO and compared with those of the control. RESULTS In the control, the CA was 584 mm2 and the maximum CP was 2.6 MPa. In case 1, the CA increased by 125% from 166 mm2 preoperatively to 375 mm2 postoperatively, accompanied by a 36% decrease in the maximum CP from 9.8 MPa to 6.3 MPa. Similarly, in case 2, the CA increased by 46% from 301 mm2 to 439 mm2, accompanied by a 27% decrease in the maximum CP from 6.7 MPa to 4.9 MPa. CONCLUSIONS This study suggests DTOO improves the biomechanics of the ankle, but not sufficiently compared to the control. This analytical approach may enhance understanding of ankle pathophysiology and assist in the design of the ideal corrective osteotomy.
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Affiliation(s)
| | | | - Kenji Kitamura
- Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JPN
| | - Hirofumi Tanaka
- Orthopedic Surgery, Hyakutake Orthopedics and Sports Clinic, Saga, JPN
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19
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Nakasa T, Ikuta Y, Sumii J, Nekomoto A, Kawabata S, Adachi N. Relationship between pain and intra-articular pathology in patients with chronic lateral ankle instability. Arch Orthop Trauma Surg 2024; 144:815-822. [PMID: 37982838 DOI: 10.1007/s00402-023-05123-2] [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: 07/10/2023] [Accepted: 10/29/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Repeated ankle sprains can lead to chronic lateral ankle instability (CLAI). It is unclear whether CLAI causes pain unless complicated by intra-articular lesions. This study aimed to analyze the characteristics of pain and the relationship between pain and intra-articular pathology in patients with CLAI. MATERIALS AND METHODS Fifty-three ankles in 46 patients with CLAI who had undergone surgery were retrospectively reviewed. The self-administered foot evaluation questionnaire (SAFE-Q) was given to patients the day before surgery. Intra-articular lesions were assessed using arthroscopy and magnetic resonance imaging (MRI). In addition, the Hounsfield Unit (HU) on computed tomography (CT) of the medial gutter was measured. The relationship between pain and intra-articular findings was also analyzed. RESULTS The pain and pain-related scores in the SAFE-Q were significantly correlated with synovitis in 96.3% (rs = - 0.532). HU ratios in the tibia and talus were also significantly correlated with pain (rs = - 0.603, - 0.534, respectively). The arthroscopic synovitis score and HU ratios in patients with high pain scores were significantly higher than those in patients with low pain scores. Forty ankles (75.5%) had synovitis and articular cartilage injuries were observed in 22 ankles (41.5%). Patients with fluid collection or bone marrow lesions (BML) scored significantly lower in pain than those without, but there was no significant difference between patients with and without cartilage injury. Multiple regression analysis revealed that a high synovitis score and HU ratio of the talus were significantly associated with high pain. CONCLUSIONS Intra-articular lesions such as synovitis and BML were associated with pain in patients with CLAI. Osteosclerotic changes in the medial gutter also induced ankle pain, indicating that osteoarthritic changes had already begun. Therefore, lateral ankle ligament injuries after ankle sprain should be appropriately treated to avoid secondary degenerative changes. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Tomoyuki Nakasa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan.
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Shingo Kawabata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
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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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Kobayashi H, Shido Y. Simultaneous hybrid closed-wedge supramalleolar osteotomy and ankle arthrodesis for post-traumatic varus ankle arthritis with periarticular deformity: A case report. Mod Rheumatol Case Rep 2023; 8:37-42. [PMID: 37300557 DOI: 10.1093/mrcr/rxad033] [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] [Received: 03/23/2023] [Revised: 05/12/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
The treatment of end-stage ankle arthritis associated with extra-articular tibial deformity, especially for ankles deformed by previous traumatic injuries and/or surgical treatment, is extremely challenging but rewarding. Only one previous report describes simultaneous tibial deformity correction and ankle arthrodesis for tibial malalignment and ipsilateral ankle arthritis. Here, we describe a unique case of post-traumatic ankle osteoarthritis concomitant with extra-articular varus deformity in a 77-year-old female. We have combined medial opening-wedge supramalleolar osteotomy (SMO) and lateral closed-wedge SMO in this case, which we termed 'hybrid' closed-wedge SMO, to overcome the limitations of traditional closed-wedge SMO. The patient was successfully treated with simultaneous hybrid closed-wedge SMO and ankle arthrodesis using a single lateral locking plate. To our knowledge, this is the first report describing the successful introduction of a hybrid closed-wedge osteotomy procedure in the distal tibia. Three years after surgery, the patient could walk without assistance and swim normally. The patient experienced no discomfort or pain in the operated ankle and was satisfied with the results. Radiographs confirmed that the pre-existing ankle joint line was parallel to the ground and almost invisible. The hind foot alignment was slightly valgus. No progression of the subtalar joint arthritis was detected. The simultaneous hybrid closed-wedge SMO and ankle arthrodesis was technically difficult but effective. This technique preserves leg length and subtalar joint motion. Additionally, a single lateral incision minimises the risk of impaired blood supply. The one-stage surgical treatment reduces the recovery time, duration of hospitalisation, and surgical costs. Rigid locking fixation with careful postoperative weight-bearing is required for uneventful bone healing.
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Affiliation(s)
- Hayato Kobayashi
- Department of Orthopaedic Surgery, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
| | - Yoji Shido
- Department of Orthopaedic Surgery, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
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Tada M, Inui K, Okano T, Koike T. Comparison of clinical and radiographic results of mobile-bearing total ankle arthroplasty between osteoarthritis and rheumatoid arthritis. Mod Rheumatol 2023; 33:1104-1109. [PMID: 36197737 DOI: 10.1093/mr/roac123] [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] [Received: 07/08/2022] [Revised: 09/07/2022] [Accepted: 09/25/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Clinical results of mobile-bearing total ankle arthroplasty (TAA) for rheumatoid arthritis (RA) have been reported, but no studies have compared osteoarthritis (OA) and RA. Clinical and radiographic outcomes after at least 3 years were compared between OA and RA. METHODS Eleven ankles with OA and 22 ankles with RA were followed after mobile-bearing TAA (FINE total ankle system). Clinical outcomes were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographic outcomes were evaluated by the angular position of the implant, radiolucent lines, migration, and subsidence. Operative and postoperative complications were assessed. RESULTS There were no significant differences in clinical outcomes, radiographic outcomes, or complications, except the final follow-up AOFAS total score (OA: 89.4 vs RA: 78.2; p = .044) and pain score (OA: 37.3 vs RA: 30.5; p = .041) at a mean follow-up of 83.4 months. Delayed wound healing occurred in 9.1% in RA and none in OA. Radiolucent lines were observed in 45% of both groups, and implant removal was performed in 9.1% and 18.2% of OA and RA, respectively; there were no significant differences. CONCLUSIONS The final follow-up AOFAS total score and pain score were significantly higher in OA after the FINE total ankle system. There was a discrepancy between radiographic abnormalities and implant removal in both OA and RA.
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Affiliation(s)
- Masahiro Tada
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Kentaro Inui
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
- Department of Orthopaedic Surgery, Osaka Metropolitan University Medical School, Osaka, Japan
| | - Tadashi Okano
- Department of Orthopaedic Surgery, Osaka Metropolitan University Medical School, Osaka, Japan
| | - Tatsuya Koike
- Search Institute for Bone and Arthritis Disease (SINBAD), Shirahama Foundation for Health and Welfare, Wakayama, Japan
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Nakajima H, Yamaguchi S, Kimura S, Mikami Y, Watanabe S, Toguchi K, Ito R, Sakamoto T, Sasho T, Ohtori S. Validity of the Center-Center Method for the Syndesmotic Fixation Axis Compared to the Transsyndesmotic Axis. Foot Ankle Int 2023; 44:1166-1173. [PMID: 37750413 DOI: 10.1177/10711007231198818] [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: 09/27/2023]
Abstract
BACKGROUND Placement of clamp forceps along the transsyndesmotic (TS) axis reduces the risk of iatrogenic syndesmotic malreduction during ankle fracture surgery with tibiofibular diastasis. This study aimed to measure the difference between the TS axis and the axis determined by an intraoperative fluoroscopic technique using the center-center (CC) method. We also compared the values obtained when the CC method was performed at different heights from the tibial plafond. METHODS We evaluated the computed tomography scans of 150 patients with normal syndesmosis. The CC method was simulated using digitally reconstructed radiographs. The TS and CC axes were projected onto an axial computed tomographic image linked to digitally reconstructed radiography. The angle between the two axes (interaxis angle) and the distance between the intersection of these axes and the medial tibial cortex (interaxis distance) were measured. The procedures were performed 0, 10, and 20 mm proximal to the tibial plafond, and the measurements were compared among the different heights using a 1-way repeated-measures analysis of variance. RESULTS The TS axis was found to be externally rotated to the CC axis, with an interaxis angle of 8.5 degrees (SD, 6.8 degrees). The interaxis angle increased from 1.9 degrees at a height of 0 mm to a greater angle at higher heights (P < .001). The overall interaxis distance was 7.7 (SD, 6.3) mm, increasing from 2.0 mm at a height of 0 mm to a greater distance at higher heights (P < .001). CONCLUSION The TS axis was externally rotated relative to the CC axis, and the difference between the 2 axes was greater when the CC method was performed on the higher heights from the tibial plafond. To clamp the syndesmosis along the TS axis, the CC method should be applied close to the ankle joint. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Hirofumi Nakajima
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Satoshi Yamaguchi
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
- Graduate School of Global and Transdisciplinary Studies, Chiba University, Inage-ku, Chiba-shi, Chiba, Japan
| | - Seiji Kimura
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Yukio Mikami
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Shotaro Watanabe
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Kaoru Toguchi
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Ryu Ito
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Takuya Sakamoto
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Takahisa Sasho
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Seiji Ohtori
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
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Miyazaki K, Maeyama A, Matsunaga T, Ishimatsu T, Yamamoto T. Pathophysiology of abnormal compensation ability of the subtalar joint in the varus knee. J Orthop Sci 2023:S0949-2658(23)00268-3. [PMID: 37852899 DOI: 10.1016/j.jos.2023.09.009] [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: 07/10/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND In recent years, the involvement of the compensation ability of the subtalar joint in lower extremity alignment has been reported. We previously showed that hindfoot alignment angle (HAA) is an indicator of compensation ability of the subtalar joint. The abnormal compensation ability of the subtalar joint was defined by the mobility of the subtalar joint, and evaluation of the mobility of the subtalar joint may help to further clarify the pathophysiology of abnormal compensation ability of the subtalar joint. This study was performed to evaluate the mobility of the subtalar joint and clarify the pathophysiology of abnormal compensation ability of the subtalar joint in the varus knee. METHODS Seventy-two knees of 72 patients aged ≥40 years with varus knee were included in this study. Preoperative radiographs were used for measurement of this study parameters. Based on our previous study, we defined HAA of ≥15.9°as abnormal compensation ability of the subtalar joint. The patients were divided into an abnormal group (A-group) and normal group (N-group). All measurement parameters were compared between the groups, and correlations between the HAA and each measurement parameter were analyzed. RESULTS The weight-bearing hindfoot angle (WBHA) (p < 0.001) and non-weight-bearing hindfoot angle (non-WBHA) (p = 0.003), were significantly greater in the A-group than in the N-group. Conversely, the ratio of change in hindfoot alignment (p = 0.006), were significantly smaller in the A-group than in the N-group. The HAA was positively correlated with WBHA (r = 0.66) and non-WBHA (r = 0.43) and negatively correlated with the ratio of change in hindfoot alignment (r = -0.32). CONCLUSIONS The pathophysiology of abnormal compensation ability of the subtalar joint in the varus knee is thought to involve a state of increased valgus of hindfoot alignment and an inability to move into normal hindfoot alignment. LEVEL OF EVIDENCE Level Ⅲ, retrospective study.
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Affiliation(s)
- Kotaro Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan-ku, Fukuoka 810-0180, Japan.
| | - Akira Maeyama
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan-ku, Fukuoka 810-0180, Japan.
| | - Taiki Matsunaga
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan-ku, Fukuoka 810-0180, Japan.
| | - Tetsuro Ishimatsu
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan-ku, Fukuoka 810-0180, Japan.
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan-ku, Fukuoka 810-0180, Japan.
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Fujimaki T, Kurokawa H, Ueno Y, Sasaki T, Pradana AS, Zainudin TNBT, Milo AM, Miyamoto T, Taniguchi A, Haro H, Tanaka Y. Assessment of Changes in Hindfoot Alignment of Total Ankle Arthroplasty for Ankle Osteoarthritis on Weightbearing Subtalar X-ray View. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231205299. [PMID: 37900557 PMCID: PMC10612447 DOI: 10.1177/24730114231205299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Background Recovering normal hindfoot alignment and correcting deformity of the ankle joint following total ankle arthroplasty (TAA) in osteoarthritis (OA) is essential for improving clinical outcomes and increasing long-term survival. We aim to evaluate hindfoot alignment following standard TAA compared to TAA with a total talar prosthesis ("combined TAA") in varus-type OA patients. Methods This retrospective study was conducted between 2010 and 2022. We included 27 patients (30 feet) who underwent standard TAA and 19 patients (22 feet) who underwent combined TAA. Hindfoot alignment at the subtalar joint was measured by weightbearing subtalar radiographic view before and after surgery. Results In the standard TAA, the angle between the tibial shaft axis and the articular surface of the talar dome joint (TTS) changed from 75 to 87 degrees (P < .01), the angle between the tibial axis and the surface on the middle facet (TMC) from 89 to 94 degrees (P < .01), and the angle between the tibial axis and the surface on the posterior facet (TPC) from 80 to 84 degrees (P < .01). The angle between the articular surface of the talar dome and the posterior facet of the calcaneus (SIA) decreased from 4.7 to -2.5 degrees (P < .01). In the combined TAA, TTS angle changed from 77 to 88 degrees (P < .01), TMC angle from 93 to 101 degrees (P < .01), TPC angle from 84 to 90 degrees (P < .05), and SIA from 6.6 to 2.1 degrees (P < .01). Varus deviation to the subtalar joint (TMC, TPC) significantly improved postoperatively in both groups. However, TPC was smaller than TTS and SIA was negative in standard TAA, and TPC was larger than TTS and SIA was positive in combined TAA. Conclusion The amount of correction of the subtalar joint differed depending on the ligament dissection of the subtalar joint and shape of the talar component. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Taro Fujimaki
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
- Department of Orthopedic Surgery, University of Yamanashi, Chou-shi, Yamanashi, Japan
| | - Hiroaki Kurokawa
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
| | - Yuki Ueno
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
| | - Takahide Sasaki
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Ananto Satya Pradana
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
| | | | - Anne Marie Milo
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
| | - Takuma Miyamoto
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
| | - Akira Taniguchi
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopedic Surgery, University of Yamanashi, Chou-shi, Yamanashi, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
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Kihara S, Kanzaki N, Yamashita T, Yamamoto T, Nishida K, Nagai K, Araki D, Hoshino Y, Matsushita T, Kuroda R. Talar component subsidence correlates with periprosthetic osteolysis after total ankle arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2987-2993. [PMID: 36930269 PMCID: PMC10504111 DOI: 10.1007/s00590-023-03519-9] [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: 11/16/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE This study aimed to investigate the relationship between periprosthetic osteolysis around the talar component and the amount of talar component subsidence after total ankle arthroplasty (TAA). METHODS This study included forty patients who underwent TAA with a mean follow-up of 67.5 ± 17.0 months. The patients were divided into two groups based on the amount of osteolysis around the talar component, as measured by computed tomography at the latest clinic visit: none to 2 mm (N group, n = 20) and greater than or equal to 2 mm (O group, n = 20). The average amount of talar component subsidence, clinical outcomes, and complications were compared between the two groups. In the O group, the correlation between osteolysis and talar component subsidence was evaluated. RESULTS The average talar component subsidence was significantly different between the N (0.22 ± 0.94 mm) and O groups (2.12 ± 2.28 mm). Five out of 20 ankles in the O group required revision surgery owing to talar component subsidence. The Japanese Society for Surgery of the Foot scores in the N and O groups were significantly different: 93.5 ± 7.7 and 85.3 ± 15.4, respectively. In the O group, we found that osteolysis tended to develop on the lateral side, and the amount of osteolysis was positively correlated with the talar component subsidence (r = 0.59, P = .007). CONCLUSION In the O group, a positive correlation between osteolysis and talar component subsidence was found, and five patients required revision surgery.
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Affiliation(s)
- Shinsuke Kihara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan.
- Department of Orthopaedic Surgery, Konan Medical Center, 1-5-16, Kamokogahara, Higashi Nada-Ku, Kobe, 658-0064, Japan.
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Takahiro Yamashita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Tetsuya Yamamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Kyohei Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Daisuke Araki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
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Onay T, Çelen ZE, Bayhan M, Kandemir İ, Kiliç NC, Kayaalp ME. A More Conservative Approach in the Surgical Management of Pediatric Physeal Ankle Fractures Should be Preferred: Mid to Long-term Functional Outcomes of Three Different Surgical Techniques for Salter-Harris Type II and Triplane Distal Tibial Fractures. J Pediatr Orthop 2023; 43:e734-e741. [PMID: 37470086 DOI: 10.1097/bpo.0000000000002471] [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] [Indexed: 07/21/2023]
Abstract
BACKGROUND Pediatric physeal ankle fractures carry a high risk of complications. This study aimed to (1) investigate the effect of anatomic reduction of the physis on mid to long-term functional outcomes in Salter-Harris type II and triplane distal tibial physeal fractures (DTPFs) and (2) compare the outcomes of 3 different surgical techniques applied in these fractures. METHODS The database of a single level-I trauma center was retrospectively reviewed for DTPFs between 2012 and 2022. A total of 39 eligible patients with operative Salter-Harris type II and triplane fractures between 2012 and 2022 were included. Surgical treatment methods were closed reduction-percutaneous fixation (CR-PF), open reduction-screw fixation, or open reduction-plate fixation. Patients were further divided into subgroups for fractures reduced anatomically (<1 mm) or nonanatomically (1 to 3 mm). The primary outcome measures were the American Orthopaedic Foot and Ankle Society Score, ankle range of motion, presence of premature physeal closure and angular deformities, and Takakura ankle osteoarthritis grade. RESULTS A total of 39 patients were included, with an average age of 12.9 ± 2.2 years. The mean follow-up time was 68.9±38.0 months. The CR-PF group had higher postoperative fracture displacement ( P = 0.011). American Orthopaedic Foot and Ankle Society scores were excellent in all groups, statistically similar between surgical techniques, and similar between anatomic and nonanatomic reduction groups. The CR-PF group ( P =0.030) and nonanatomic reduction ( P = 0.030) provided a significantly lower ankle osteoarthritis rate. All 4 patients with premature physeal closure were observed in patients treated with open techniques. CONCLUSIONS CR-PF for the treatment of DTPFs should be preferred in suitable cases as it is less invasive and provides satisfactory mid to long-term functional outcomes without increasing complications compared with anatomic reduction and open techniques. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Tolga Onay
- Department of Orthopaedics and Traumatology, Göztepe Training and Research Hospital, Istanbul Medeniyet University
| | - Zekeriya Ersin Çelen
- Department of Orthopaedics and Traumatology, Kartal Dr. Lütfi Kirdar City Hospital, University of Health Sciences, Istanbul
| | - Mazlum Bayhan
- Department of Orthopaedics and Traumatology, Yalova State Hospital, Yalova, Turkey
| | - İbrahim Kandemir
- Department of Orthopaedics and Traumatology, Yalova State Hospital, Yalova, Turkey
| | - Nazim Canberk Kiliç
- Department of Orthopaedics and Traumatology, Yalova State Hospital, Yalova, Turkey
| | - Mahmut Enes Kayaalp
- Department of Orthopaedics and Traumatology, Yalova State Hospital, Yalova, Turkey
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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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Abstract
Weight-bearing computed tomography (WBCT) was introduced in 2012 for foot and ankle applications as a breakthrough technology that enables full weight-bearing, three-dimensional imaging unaffected by x-ray beam projections or foot orientation. The literature describing the use of WBCT in the treatment of foot and ankle disorders is growing, and this article provides an overview of what can be measured with WBCT.
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Affiliation(s)
- Jaeyoung Kim
- Foot and Ankle Service, Hospital for Special Surgery, 532 East 72nd Street, New York, NY, USA
| | - Scott Ellis
- Foot and Ankle Service, Hospital for Special Surgery, 532 East 72nd Street, New York, NY, USA
| | - John A Carrino
- Department of Radiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
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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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Zhang S, Sun C, Zhang J, Wang Z, Li S, Zhang M. Subchondral bone cysts remodel after correction of varus deformity in ankle arthritis. Foot Ankle Surg 2023; 29:419-423. [PMID: 37277300 DOI: 10.1016/j.fas.2023.05.008] [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: 02/04/2023] [Revised: 05/02/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Subchondral bone cysts (SBCs) of the talus are frequently observed in ankle osteoarthritis (OA). It is unclear whether the cysts need direct treatment after correction of the varus deformity in ankle OA. The purpose of this study is to investigate the incidence of SBCs and the change after supramalleolar osteotomy (SMOT). METHODS Thirty-one patients treated by SMOT were retrospectively reviewed, and 11 ankles had cysts preoperatively. After SMOT without management of the cysts, the evolution of cysts was evaluated on weightbearing computerized tomography (WBCT). The American Orthopaedic Foot and Ankle Society (AOFAS) clinical ankle-hindfoot scale and a visual analog scale (VAS) were compared. RESULTS At baseline, the average cyst volume was 65.86 ± 60.53 mm3. The number and volume of cysts were reduced dramatically (P<.05), and the cysts vanished in 6 ankles after the SMOT. The VAS and AOFAS scores improved significantly after SMOT (P<.001), there was no significant difference between ankles with cysts and without cysts. CONCLUSIONS The SMOT alone without direct treatment of the SBCs led to a decrease in the number and volume of SBCs in varus ankle OA. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Shu Zhang
- Foot and Ankle Surgery Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chao Sun
- Foot and Ankle Surgery Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jianzhong Zhang
- Foot and Ankle Surgery Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhi Wang
- Foot and Ankle Surgery Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shuyuan Li
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, USA
| | - Mingzhu Zhang
- Foot and Ankle Surgery Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 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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Kurokawa H, Taniguchi A, Ueno Y, Miyamoto T, Tanaka Y. Risk Factors for the Progression of Varus Ankle Osteoarthritis. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231178763. [PMID: 37332631 PMCID: PMC10272656 DOI: 10.1177/24730114231178763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
Background With the increase in life expectancy, the prevalence of ankle osteoarthritis (OA) is also expected to increase in the future. Functional disability and diminished quality of life associated with end-stage ankle OA are comparable to those associated with end-stage hip or knee OA. However, there are few reports on the natural history and progression of patients with ankle OA. Hence, this study aimed to evaluate the risk factors for progression in patients with varus ankle OA. Methods We evaluated 68 ankles from 58 patients diagnosed with varus ankle OA using radiography performed at intervals over at least 60 months. The mean follow-up period was 99 ± 40 months. Narrowing of the joint space and increasing osteophyte formation were defined as ankle OA progression. Multivariate analysis was performed using logistic regression to predict the odds of progression; the model included 2 clinical variables and 7 radiographic variables. Results Of the 68 ankles, 39 (57%) progressed. In multivariable logistic regression analyses, patient's age (odds ratio [OR] 0.92, 95% CI 0.85-0.99, P < .03), and the talar tilt (TT; OR 2.2, 95% CI 1.39-3.42, P = .001) were found to be independent factors for progression. The area under the curve (AUC) of the receiver operating characteristic curve for TT was 0.844, and the cutoff value was 2.0 degrees. Conclusion TT was found to be a primary factor associated with varus ankle OA progression. The risk appeared higher in patients with a TT more than 2.0 degrees. Level of Evidence Level III, retrospective case control study.
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Affiliation(s)
| | | | - Yuki Ueno
- Nara Medical University, Kashihara, Nara, Japan
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Kimura S, Yamaguchi S, Mikami Y, Nakajima H, Watanabe S, Sasho T, Ohtori S. Stress Fracture of the Ankle Medial Malleolus in Patients With Severe Varus Ankle Osteoarthritis: A Report of 5 Cases. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231183440. [PMID: 37425341 PMCID: PMC10328028 DOI: 10.1177/24730114231183440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Affiliation(s)
- Seiji Kimura
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba-shi, Chiba, Japan
| | - Satoshi Yamaguchi
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba-shi, Chiba, Japan
- Graduate School of Global and Transdisciplinary Studies, Chiba University, Chiba-shi, Chiba, Japan
| | - Yukio Mikami
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba-shi, Chiba, Japan
| | - Hirofumi Nakajima
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba-shi, Chiba, Japan
| | - Shotaro Watanabe
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba-shi, Chiba, Japan
| | - Takahisa Sasho
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba-shi, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba-shi, Chiba, Japan
| | - Seiji Ohtori
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba-shi, Chiba, Japan
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Amaha K, Yamaguchi S, Teramoto A, Kawasaki Y, Shiko Y, Kitamura N. Clinical outcomes of surgical treatment for end-stage ankle osteoarthritis in patients aged ≥ 75 years: a multicenter, retrospective study. J Orthop Surg Res 2023; 18:244. [PMID: 36966317 PMCID: PMC10039590 DOI: 10.1186/s13018-023-03734-4] [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: 02/04/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND This study aimed to clarify the clinical outcomes of surgical treatment for end-stage ankle osteoarthritis in patients aged ≥ 75 years and compare these outcomes with those of patients aged < 75 years. METHODS A total of 148 patients, including 65 who underwent total ankle arthroplasty and 83 who underwent ankle arthrodesis, were retrospectively surveyed. Clinical outcomes were assessed preoperatively and at the last follow-up using the Japanese Society for Surgery of the Foot Hindfoot Scale and a self-administered foot evaluation questionnaire (SAFE-Q). Patient characteristics, including age, sex, body mass index, radiographic severity, and follow-up period, were also assessed. The patients were divided into older (≥ 75 years) and younger (< 75 years) age groups. Improvements in outcomes were then compared between age groups using univariate analysis and analysis of covariance adjusted for patient characteristics. Total ankle arthroplasty and ankle arthrodesis were analyzed separately. RESULTS All clinical outcome scores improved postoperatively in the older age groups for both procedures. Scores for the pain and pain-related subscale of the SAFE-Q improved by 37 points (p < 0.001) in post-total ankle arthroplasty patients and by 35 points in post-ankle arthrodesis patients (p < 0.001). Furthermore, multivariate analysis showed that the improvements observed in all scores were not different between the older and younger age groups for both post-total ankle arthroplasty and post-ankle arthrodesis patients, except for the SAFE-Q physical functioning subscale score for post-ankle arthrodesis patients. The clinical outcomes improved significantly in post-total ankle arthroplasty and post-ankle arthrodesis patients aged ≥ 75 years. Moreover, these improvements were similar to those observed in patients aged < 75 years. CONCLUSIONS Surgical treatment of end-stage ankle osteoarthritis can be a viable treatment option, even in elderly patients, and can be expected to improve similarly to younger patients.
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Affiliation(s)
- Kentaro Amaha
- Department of Orthopedic Surgery, St Luke's International Hospital, Akashi-cho, Chuo-ku, Tokyo, Japan.
| | - Satoshi Yamaguchi
- Graduate School of Global and Transdisciplinary Studies, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Inohana, Chuo-ku, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Inohana, Chuo-ku, Chiba, Japan
| | - Nobuto Kitamura
- Department of Orthopedic Surgery, St Luke's International Hospital, Akashi-cho, Chuo-ku, Tokyo, Japan
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Park YH, Lee HJ, Choi JW, Kim HJ. Value of postoperative computed tomography for the diagnosis of lateral hinge fracture in medial opening-wedge supramalleolar osteotomy. Arch Orthop Trauma Surg 2023; 143:1379-1385. [PMID: 35039915 DOI: 10.1007/s00402-021-04301-4] [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: 10/15/2021] [Accepted: 12/02/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION It remains unclear whether computed tomography (CT) is superior to plain radiography in detecting lateral hinge fractures after medial opening-wedge supramalleolar osteotomy (SMO) of the ankle joint. This study aimed to evaluate the disparity between postoperative plain radiography and CT in detecting lateral hinge fractures after medial opening-wedge SMO and to identify the predictive factors of lateral hinge fractures. MATERIALS AND METHODS This retrospective study included 39 patients who underwent medial opening-wedge SMO. The immediate postoperative plain radiography and CT scan images were retrieved, and the presence of lateral hinge fractures was independently determined. Depending on the fracture gap, the lateral hinge fractures were subclassified as stable (gap < 2 mm) or unstable (gap ≥ 2 mm) fractures. To investigate the predictive factors, the cases were divided based on diagnostic tools such as plain radiography and CT. RESULTS The incidence of lateral hinge fractures was 48.7% (19/39) on plain radiographs and 61.5% (24/39) on CT scans. Five cases of lateral hinge fractures additionally detected on CT scans were stable fractures, and all had been classified as no fracture on plain radiographs. The unstable fractures that had been subclassified based on plain radiographs did not change on CT scans. None of the variables were associated with the presence of lateral hinge fractures on plain radiographs and CT scans. CONCLUSIONS Postoperative CT after medial opening-wedge SMO has no additional diagnostic value if the lateral hinge fracture has already been diagnosed on plain radiography. Therefore, postoperative CT is only recommended when lateral hinge fractures are not visible on plain radiographs.
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Affiliation(s)
- Young Hwan Park
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - Ho Jae Lee
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - Jung Woo Choi
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Korea.
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Supramalleolar osteotomy for the treatment of ankle osteoarthritis leads to favourable outcomes and low complication rates at mid-term follow-up: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:701-715. [PMID: 36151410 DOI: 10.1007/s00167-022-07144-7] [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: 05/18/2022] [Accepted: 08/26/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this systematic review was to evaluate both the clinical and radiographic outcomes following supramalleolar osteotomy (SMO) in patients with ankle osteoarthritis, and to analyse the level of evidence (LOE) and quality of evidence (QOE) of the included studies. METHODS A systematic review of the MEDLINE, EMBASE, and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting clinical data following SMO for the treatment of ankle osteoarthritis were included and assessed. The level and quality of evidence of the included studies were also evaluated. RESULTS Twenty-four studies with 1160 patients (1182 ankles) were included. Overall, 78.8% patients presented with post-traumatic ankle osteoarthritis. The weighted mean AOFAS score improved from 52.6 ± 9.7 (range 33.8-78.4) preoperatively to 78.1 ± 5.7 postoperatively at weighted mean follow-up of 50.4 ± 18.6 months (range 24.5-99.0). The most frequently utilised radiographic parameter was the tibial anterior surface angle, which improved from a preoperative weighted mean of 86.3° ± 5.6° (range 76.0°-102.0°) to a postoperative weighted mean of 89.9° ± 3.7° (range 84.9°-99.6°). The complication rate was 5.1% with non-union as the most commonly reported complication (1.6%). Secondary procedures were carried out in 28.2% of patients, the most common of which was implant and hardware removal (17.6%). The failure rate was 6.8%. Two studies were LOE II, 3 studies were LOE III, and 19 studies were LOE IV. The mean Modified Coleman Methodology Score was 59.3 ± 6.6 and the mean MINORS criteria score of all the included studies was 9.5 ± 3.7. CONCLUSION This systematic review demonstrates good clinical and radiological outcomes, together with a low failure rate at mid-term follow-up following supramalleolar osteotomy in patients with ankle osteoarthritis. However, a moderate reoperation rate (28.2%) was reported. A low failure rate (6.8%) was reported, which must be interpreted in light of the shortcomings of the design of the included studies and a relatively short follow-up period. In addition, there is a low level and quality of evidence in the current literature with inconsistent reporting of data which underscores the need for further higher quality research to be conducted. Our review highlights that SMO may be an effective and safe procedure in the setting of early-to-intermediate-stage ankle osteoarthritis. LEVEL OF EVIDENCE IV.
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Morohashi I, Mogami A, Wakeshima T, Kameda S, Matsuo T, Muraoka T, Obayashi O, Kaneko K, Ishijima M. Early results of intramedullary nail fixation in distal tibia oblique osteotomy for the reduction of soft tissue complications. J Orthop Surg (Hong Kong) 2023; 31:10225536231157136. [PMID: 36785987 DOI: 10.1177/10225536231157136] [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: 02/15/2023] Open
Abstract
PURPOSE During distal tibial oblique osteotomy, external fixators can increase pin site infection risk, whereas plates can cause wound necrosis, necessitating a compromise between soft-tissue position and length. We provide the first report of the early results of intramedullary nail fixation in these osteotomies for avoiding soft tissue complications. METHODS Ten ankles, classed as Takakura-Tanaka stages 3a to 4 and unclassified and treated via distal tibial oblique osteotomy for ankle osteoarthritis between 2017 and 2021, were included. Osteotomy was performed obliquely from the distal medial tibia to the tibiofibular joint. The distal tibial fragment was rotated distally in the coronal plane for realignment. An intramedullary nail fixation was applied for stabilization. The resulting gap was filled with iliac bone graft. Ankles were evaluated on the Japanese Society for Surgery of the Foot ankle-Hindfoot Scale and Self-Administered Foot Evaluation Questionnaire before surgery and at final follow-up. Radiographic assessments were performed. RESULTS Bone union was achieved within 3 months in all patients. There were no cases of wound necrosis or correction loss postsurgery. Japanese Society scale scores significantly improved from 40.3 ± 15.9 to 87.5 ± 12.6 (P < 0.01). Mean self-evaluation scale scores (pain and pain-related, physical functioning and daily living, social functioning, general health and well-being) improved significantly. shoe-related scores did not change significantly but improved. There was no correction loss after surgery, with an average widening of 24.2 mm and opening angle of 22.6° at the osteotomy site. CONCLUSION Our study showed that intramedullary nail for fixation of the osteotomy site in distal tibial oblique osteotomy effectively prevents soft tissues complications even in osteotomy sites with large openings.
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Affiliation(s)
- Itaru Morohashi
- Department of Orthopaedic Surgery, 73832Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Atsuhiko Mogami
- Department of Orthopaedic Surgery, 73832Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Tomoko Wakeshima
- Department of Orthopaedic Surgery, 73832Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - So Kameda
- Department of Orthopaedic Surgery, Kameda Hospital, Yokohama, Japan
| | | | | | - Osamu Obayashi
- Department of Orthopaedic Surgery, 73832Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Kazuo Kaneko
- 12847Juntendo University, Bunkyo-ku, Tokyo, Japan
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Indirect drainage using hindfoot endoscopy for the treatment of recurrent ganglion cysts of the hallux associated with ankle osteoarthritis: A report of two cases. J Orthop Sci 2023; 28:282-285. [PMID: 32571531 DOI: 10.1016/j.jos.2020.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/10/2020] [Accepted: 04/23/2020] [Indexed: 01/10/2023]
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Miyazaki K, Maeyama A, Yoshimura I, Kobayashi T, Ishimatsu T, Yamamoto T. Influence of hindfoot alignment on postoperative lower limb alignment in medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg 2023; 143:81-90. [PMID: 34145498 DOI: 10.1007/s00402-021-04001-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/14/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We have experienced unexpected under-correction after medial opening wedge high tibial osteotomy (MOWHTO). Although the tibia was corrected accurately, the postoperative mechanical axis (MA) was less than 57%. The purpose of this study was to evaluate the relationship between hindfoot alignment and postoperative lower limb alignment, and to reveal whether hindfoot alignment affects lower limb alignment after MOWHTO. Our hypothesis was that hindfoot alignment influences the postoperative MA in MOWHTO. MATERIALS AND METHODS This study was a retrospective comparative study. The study cohort comprised 43 knees in 43 patients who underwent MOWHTO and had standing long-leg anteroposterior view and hindfoot alignment view radiographs taken preoperatively and at 3 months postoperatively. To evaluate the hindfoot alignment, the absolute value of the ankle joint line orientation relative to the ground was added to the absolute value of the hindfoot angle. We defined a postoperative MA of 57-67% as acceptable correction (A group) and a MA of < 56% as under-correction (U group). The two groups were analyzed to identify factors that affected postoperative limb alignment. RESULTS The preoperative hindfoot alignment angle was significantly larger in the U group than the A group. The preoperative hindfoot alignment angle was a significant predictive factor of the postoperative MA, and the cut-off value that distinguished under-correction from acceptable correction was 15.9 degrees. CONCLUSION Abnormal hindfoot alignment is one of the causes of under-correction after MOWHTO. Attention should be paid to the preoperative ankle joint line orientation relative to the ground and hindfoot angle. If the preoperative hindfoot alignment angle is ≥ 15.9 degrees, surgeons should reconsider the operative procedure and correction angle. LEVEL OF EVIDENCE Therapeutic level III, retrospective study.
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Affiliation(s)
- Kotaro Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan
| | - Akira Maeyama
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan.
| | - Ichiro Yoshimura
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan
| | - Tomohiro Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan
| | - Tetsuro Ishimatsu
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan
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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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Ahn J, Son HS, Jeong BO. Clinical Outcomes of Supramalleolar Osteotomy in Intermediate Stage of Varus Ankle Osteoarthritis in Joint Preservation. J Foot Ankle Surg 2022; 61:1280-1286. [PMID: 35585001 DOI: 10.1053/j.jfas.2022.04.002] [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] [Received: 10/12/2020] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 02/03/2023]
Abstract
Supramalleolar osteotomy (SMO) is an effective treatment for intermediate-stage varus ankle osteoarthritis (OA). This study aimed to investigate how clinical outcomes were associated with radiological changes and cartilage regeneration shown on arthroscopy before and after SMO in patients with intermediate-stage varus ankle OA. Twenty-six cases with intermediate-stage varus ankle OA underwent SMO with at least 1 year of postoperative follow-up. Clinical assessment was performed preoperatively and postoperatively using the visual analog scale (VAS), American Orthopedic Foot and Ankle Society ankle-hindfoot (AOFAS) scores, and their associations with postoperative changes in tibial ankle surface angle (TAS), talar tilt, tibial lateral surface angle, and heel alignment ratio. The degrees of cartilage regeneration in the tibia plafond and talar dome were observed via second-look arthroscopy. Afterward, their associations with the corresponding clinical outcomes were analyzed. There were significant changes in the TAS, talar tilt, and heel alignment ratio (p < .001, for all). However, there were no significant changes in the tibial lateral surface angle (p = .864) at the final follow-up compared to its preoperative value. Postoperative changes in TAS (p = .013) and the degree of cartilage regeneration (p = .028) in the talar dome significantly influenced the final follow-up AOFAS score. Changes in the TAS angle and the degree of cartilage regeneration after SMO were predictors of clinical outcomes after SMO. In particular, greater changes in the TAS angle corresponded to better clinical outcomes.
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Affiliation(s)
- Jungtae Ahn
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyuck Sung Son
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Bi O Jeong
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
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Lai L, Wang Y, Wu Y, Sun N, Li Y, Du H, Gong X. Outcomes of intermediate stage varus ankle arthritis treated by supramalleolar osteotomy. J Orthop Surg (Hong Kong) 2022; 30:10225536221132769. [PMID: 36197148 DOI: 10.1177/10225536221132769] [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: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate the outcomes of intermediate stage varus ankle arthritis treated by supramalleolar osteotomy. METHODS Clinical data of 57 patients with varus arthritis who underwent supramalleolar osteotomy at our hospital between March 2018 and December 2019 were retrospectively analyzed. The patients were grouped according to the Takakura classification, and assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and the Visual Analogue Score (VAS). Tibial anterior surface (TAS) angle and talar tilt (TT) angle were measured at the weight-bearing anteroposterior view. Tibial lateral surface (TLS) angle was measured at the weight-bearing lateral view. The differences in the above indicators of patients with different stages of varus ankle arthritis before and after treatment were analyzed. RESULTS The patients were followed up for an average of 31.9 ± 5.8 months. Upon the last follow-up, the AOFAS score was 84.1 ± 9.7, the VAS score 2.2 ± 1.3, the TAS angle 92.4 ± 5.5°, the TLS angle 79.3 ± 5.3°, and the TT angle 3.7±3.4°, which were significantly different from the preoperative levels (64.2 ± 14.6, 4.5 ± 1.8, 80.5 ± 6.7°, 74.9 ± 4.6°, and 5.2 ± 64.1°, respectively) (p < .05). There were significant differences in AOFAS and VAS scores before surgery and upon the last follow-up in each group (p < .05). The postoperative TT angle was significantly different from the preoperative level in stage IIIb patients (p = .003). CONCLUSIONS Supramalleolar osteotomy achieved good short-to mid-term clinical outcomes for intermediate stage varus ankle arthritis. This procedure could significantly improve the TAS and TLS angles of the patients at any stage and the TT angle of stage IIIb patients.
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Affiliation(s)
- Liangpeng Lai
- Department of Foot and Ankle Surgery, 66526Beijing Jishuitan Hospital(Fourth Clinical Medical School of Peking University), China
| | - Yan Wang
- Department of Foot and Ankle Surgery, 66526Beijing Jishuitan Hospital(Fourth Clinical Medical School of Peking University), China
| | - Yong Wu
- Department of Foot and Ankle Surgery, 66526Beijing Jishuitan Hospital(Fourth Clinical Medical School of Peking University), China
| | - Ning Sun
- Department of Foot and Ankle Surgery, 66526Beijing Jishuitan Hospital(Fourth Clinical Medical School of Peking University), China
| | - Ying Li
- Department of Foot and Ankle Surgery, 66526Beijing Jishuitan Hospital(Fourth Clinical Medical School of Peking University), China
| | - Hui Du
- Department of Foot and Ankle Surgery, 66526Beijing Jishuitan Hospital(Fourth Clinical Medical School of Peking University), China
| | - Xiaofeng Gong
- Department of Foot and Ankle Surgery, 66526Beijing Jishuitan Hospital(Fourth Clinical Medical School of Peking University), China
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Wanezaki Y, Suzuki A, Takakubo Y, Nakajima T, Toyono S, Toyoshima S, Hariu M, Okada S, Ishikawa H, Takagi M. Evaluation of hindfoot and knee alignment by the hip-to-calcaneus view in patients with knee osteoarthritis and healthy individuals. Knee 2022; 38:184-192. [PMID: 36087373 DOI: 10.1016/j.knee.2022.08.014] [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: 02/17/2022] [Revised: 07/11/2022] [Accepted: 08/23/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip-to-calcaneus (HC) view is a whole-leg standing view that can visualize the hindfoot in detail. The aim of this study was to investigate the reliability and validity of tibiocalcaneal angle in HC view (H-TCA) by comparing it with that in long axial view (L-TCA). We also verified whether periarticular knee alignment parameters, measured conventionally in whole-leg standing radiography, could be measured in HC view. METHOD Sixty healthy volunteers and 61 patients with medial knee osteoarthritis were included. H-TCA was measured by two examiners in the healthy group, and intra-class correlation coefficients (ICCs) were evaluated. H-TCA and L-TCA were then measured in the healthy and osteoarthritis groups and correlated. Finally, we measured hip-knee-ankle angle, mechanical axis deviation ratio, mechanical lateral distal femoral angle, medial proximal tibial angle, and joint-line convergence angle in HC view and conventional whole-leg standing radiography to evaluate statistical differences and correlations. RESULTS The intra-observer and inter-observer ICCs were 0.86 and 0.76, respectively. Correlation coefficients (r) between H-TCA and L-TCA were r = 0.87 in healthy group and r = 0.81 in osteoarthritis group, indicating a strong positive correlation in both groups. There was no significant difference in periarticular knee alignment parameters between HC view and conventional whole-leg radiography. CONCLUSIONS Hindfoot evaluation in HC view showed high intra-observer and inter-observer reliabilities and strong positive correlation with TCA in long axial view. By using HC view before knee surgery, such as total knee arthroplasty, other necessary alignments can be evaluated simultaneously.
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Affiliation(s)
- Yoshihiro Wanezaki
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata-city, Yamagata, Japan.
| | - Akemi Suzuki
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata-city, Yamagata, Japan
| | - Yuya Takakubo
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata-city, Yamagata, Japan
| | - Taku Nakajima
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata-city, Yamagata, Japan
| | - Shuji Toyono
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata-city, Yamagata, Japan
| | - Sadami Toyoshima
- Department of Orthopedic Surgery, Miyukikai Hospital, Kaminoyama, Yamagata, Japan
| | - Mitsuhiro Hariu
- Department of Orthopedic Surgery, Yamagata Prefectural Shinjo Hospital, Shinjo, Yamagata, Japan
| | - Soichiro Okada
- Department of Orthopedic Surgery, Yamagata Prefectural Shinjo Hospital, Shinjo, Yamagata, Japan
| | - Hitoshi Ishikawa
- Department of Public Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata-city, Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata-city, Yamagata, Japan
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Liu T, Dong SJ, Li WL, Wang D, Zheng YP, Qu WQ. Ankle Arthrodesis Combined With Mosaic Bone Autograft Transplantation for End-Stage Ankle Osteoarthritis With Large Cysts of Talar Dome. J Foot Ankle Surg 2022; 61:932-937. [PMID: 35649964 DOI: 10.1053/j.jfas.2021.11.016] [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: 06/25/2019] [Revised: 06/08/2020] [Accepted: 11/28/2021] [Indexed: 02/03/2023]
Abstract
End-stage ankle osteoarthritis with large cysts of talar dome can be challenging to treat. Twenty patients diagnosed as end-stage ankle arthritis with large talar cysts between 04/2010 and 02/2016 were randomly divided into experimental group (10 cases) and conventional group (10 cases) by random number method. Patients in the experimental group were treated with ankle arthrodesis combined with a concomitant procedure of mosaic bone autograft transplantation, the conventional group under the ankle arthrodesis. The operation time, intraoperative blood loss, postoperative hospital stay, the time of bone union, and postoperative height of the talus between the 2 groups were compared. The preoperative and postoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score were also recorded and compared. There was no significant difference in the operation time, intraoperative blood loss, and postoperative hospital stay between the 2 groups. The postoperative height of the talus body and the time of bone union were better in the experimental group than that in the conventional group (p < .05). The results of follow-up showed that the American Orthopaedic Foot and Ankle Society scores of the conventional group were lower than those in the experimental group (p < .001). And the incidence of complication (10%) in the experimental group was significantly lower than that in the conventional group (40%). The use of tibiotalar arthrodesis combined with mosaic bone autograft transfer may be potentially an effective option for the treatment of end-stage ankle arthritis with large talar cysts.
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Affiliation(s)
- Tong Liu
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China
| | - Sheng-Jie Dong
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China
| | - Wen-Liang Li
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China
| | - Dan Wang
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China
| | - Yan-Ping Zheng
- Department of Orthopaedics, Qilu Hospital (Qingdao) of Shandong University, Jinan, Shandong, China
| | - Wen-Qing Qu
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China; Department of Orthopaedics, Qilu Hospital (Qingdao) of Shandong University, Jinan, Shandong, China.
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Caravelli S, Puccetti G, Vocale E, Di Ponte M, Pungetti C, Baiardi A, Grassi A, Mosca M. Reconstructive Surgery and Joint-Sparing Surgery in Valgus and Varus Ankle Deformities: A Comprehensive Review. J Clin Med 2022; 11:jcm11185288. [PMID: 36142935 PMCID: PMC9504878 DOI: 10.3390/jcm11185288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/22/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022] Open
Abstract
Osteoarthritis (OA) of the ankle affects about 1% of the world’s adult population, causing an important impact on patient lives and health systems. Most patients with ankle OA can show an asymmetrical wear pattern with a predominant degeneration of the medial or the lateral portion of the joint. To avoid more invasive ankle joint sacrificing procedures, joint realignment surgery has been developed to restore the anatomy of the joints with asymmetric early OA and to improve the joint biomechanics and symptoms of the patients. This narrative, comprehensive, all-embracing review of the literature has the aim to describe the current concepts of joint preserving and reconstructive surgery in the treatment of the valgus and varus ankle early OA, through an original iconography and clear indications and technical notes.
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Affiliation(s)
- Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence:
| | - Giulia Puccetti
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Emanuele Vocale
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Camilla Pungetti
- Department Orthopaedics and Traumatology, Ospedale Maggiore “Pizzardi”, 40133 Bologna, Italy
| | - Annalisa Baiardi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Grassi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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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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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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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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