Low tibial osteotomy for moderate ankle arthritis

Abstract Background: Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. With tibiotalar arthrodesis, high levels of pain-free function are possible; however, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator on ankle osteoarthritis. Methods: A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed. Subsequently, angled osteotomy and correction of the distal tibia were performed. After ankle conditions improved, stabilization of the ankle joint was performed. An external fixator was used in all patients. In addition, joint distraction of about 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery. Results: The anteroposterior mortise angle during weight-bearing, lateral mortise angle during weight-bearing, and talar tilt angle and anterior translation of the talus on ankle stress radiography significantly improved (P < 0.05). In addition, signal changes on magnetic resonance imaging improved in all patients. Visual analogue scale and American Orthopedic Foot & Ankle Society scores also improved significantly (P < 0.05). No severe complications were observed. Conclusion: DTO with joint distraction may be useful for older patients with a high physical activity level as a joint-preserving surgery for medial ankle osteoarthritis. Level of evidence: Level IV, retrospective case series Key words : distal tibial osteotomy, medial ankle arthritis, joint distraction, circular external fixator

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Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

10.21203/rs.2.17170/v3 ◽

2020 ◽

Author(s):

Koji Nozaka ◽

Naohisa Miyakoshi ◽

Takeshi Kashiwagura ◽

Yuji Kasukawa ◽

Hidetomo Saito ◽

...

Keyword(s):

Ankle Joint ◽

External Fixator ◽

Weight Bearing ◽

Tibial Osteotomy ◽

Ankle Arthritis ◽

Ankle Osteoarthritis ◽

Distraction Arthroplasty ◽

Circular External Fixator ◽

Joint Distraction ◽

Tibiotalar Arthrodesis

Abstract Background: Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. With tibiotalar arthrodesis, high levels of pain-free function are possible; however, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator on ankle osteoarthritis. Methods: A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed. Subsequently, angled osteotomy and correction of the distal tibia were performed. After ankle conditions improved, stabilization of the ankle joint was performed. An external fixator was used in all patients. In addition, joint distraction of about 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery. Results: The anteroposterior mortise angle during weight-bearing, lateral mortise angle during weight-bearing, and talar tilt angle and anterior translation of the talus on ankle stress radiography significantly improved (P < 0.05). In addition, signal changes on magnetic resonance imaging improved in all patients. Visual analogue scale and American Orthopedic Foot & Ankle Society scores also improved significantly (P < 0.05). No severe complications were observed. Conclusion: DTO with joint distraction may be useful for older patients with a high physical activity level as a joint-preserving surgery for medial ankle osteoarthritis. Level of evidence: Level IV, retrospective case series Key words : distal tibial osteotomy, medial ankle arthritis, joint distraction, circular external fixator

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Radiographic Outcomes of Proximal vs Distal Syndesmotic Low Tibial Osteotomy

Foot & Ankle International ◽

10.1177/10711007211035784 ◽

2021 ◽

pp. 107110072110357

Author(s):

Jun Young Choi ◽

Jin Ho Cho ◽

Tae Hun Song ◽

Jin Soo Suh

Keyword(s):

Tibial Osteotomy ◽

Ankle Arthritis ◽

Level Of Evidence ◽

Radiographic Findings ◽

Fibular Osteotomy ◽

Radiographic Outcomes ◽

Intermalleolar Distance ◽

Talar Tilt ◽

Retrospective Comparative Study ◽

Distance Correction

Background: We aimed to determine whether the location of tibial osteotomy affects the outcome during low tibial osteotomy (LTO) with fibular osteotomy for varus ankle arthritis by comparing proximal syndesmotic (PS) and distal syndesmotic (DS) tibial osteotomy. Methods: We retrospectively reviewed the radiographic findings of 50 cases (among 47 patients) who underwent LTO with fibular osteotomy for varus ankle arthritis. The enrolled patients were divided into 2 groups according to the location of the tibial osteotomy: the PS group (25 cases, 24 patients) and the DS group (25 cases, 23 patients). Radiographic parameters were compared between the 2 groups. Results: There were no significant differences in tibial anterior and lateral surface angles, tibiomedial malleolar angle, talar center migration, and intermalleolar distance correction between the 2 groups (all P > .05). However, the decreases in talar tilt (TT) and talocrural angle (TCA) were more pronounced in the DS group than in the PS group (both P < .05). Among patients with TT ≥8 degrees, a greater decrease in TT (+1.0 degrees vs –2.8 degrees) and TCA was observed in the DS group, whereas the PS group demonstrated greater increases in TCA and intermalleolar distance (all P < .01). Conclusion: In this series, DS tibial osteotomy combined with fibular osteotomy was a more effective operative option than PS tibial osteotomy to correct both extra- and intra-articular deformity for varus ankle arthritis. Level of evidence: Level III, retrospective comparative study.

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Benefit of Adding Fibular Osteotomy to Open-Wedge, Valgus, Distal Tibial Osteotomy for Correcting Varus Ankle Arthritis: An In Vitro Study

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2016.11.018 ◽

2017 ◽

Vol 56 (2) ◽

pp. 234-237

Author(s):

Thos Harnroongroj ◽

Bavornrit Chuckpaiwong

Keyword(s):

In Vitro Study ◽

Vitro Study ◽

Tibial Osteotomy ◽

Open Wedge ◽

Ankle Arthritis ◽

Fibular Osteotomy

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Comparison of Treatment between Distal Tibial Osteotomy without Fibular Osteotomy and Tibiotalar Arthrodesis for Medial Ankle Arthritis in Older Individuals

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000309 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Koji Nozaka ◽

Takeshi Kashiwagura ◽

Hideji Kura

Keyword(s):

Physical Component Score ◽

Tibial Osteotomy ◽

Older Individuals ◽

Ankle Arthritis ◽

Ankle Osteoarthritis ◽

Component Score ◽

Sf 36 ◽

Circular External Fixator ◽

Tibiotalar Arthrodesis ◽

The Mean

Category: Ankle Arthritis Introduction/Purpose: Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. Distal tibial osteotomy without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years, but patient satisfaction has yet to be compared between the two treatments. Objective: To compare distal tibial osteotomy and tibiotalar arthrodesis for ankle osteoarthritis (stage IIIb and above under the Takakura classification) in older individuals. Methods: Subjects and Method: A total of 35 patients aged>60 years old who showed medial ankle arthritis were examined. Patients were either treated with tibiotalar arthrodesis (n=18) or distal tibial osteotomy (n=17). The patients’ mean age was 72.1 years (range, 60–81 years) in the tibiotalar arthrodesis group and 67.2 years (range, 60–80 years) in the distal tibial osteotomy group. For distal tibial osteotomy, a circular external fixator was used in all cases. Osteotomy was performed after performing synovectomy and microfracture surgery using ankle arthroscopy. At the time of fixation with a circular external fixator, foot ring (calcaneal) fixation was also performed. In addition, joint distraction was performed, and distraction arthroplasty was also simultaneously performed. Results: The mean preoperative VAS score was 8.2 for tibiotalar arthrodesis (TA) and 8.0 for distal tibial osteotomy (DTO). The mean postoperative VAS score was 1.9 for TA and 1.7 for DTO. The mean preoperative AOFAS score was 40.1 for TA and 43.1 for DTO. The mean postoperative AOFAS score was 86.2 for TA and 90.0 for DTO. The mean preoperative SF-36 physical component score was 30.5 for TA and 38.5 for DTO. The mean preoperative SF-36 mental component score was 33.5 for TA and 37.5 for DTO. The mean postoperative SF-36 physical component score was 42.5 for TA and 56.4 for DTO. It was significantly higher with the DTO (p<0.05). Conclusion: The mean postoperative SF-36 mental component score was 44.0 for TA and 59.7 for DTO. It was significantly higher with the DTO (p<0.05).Superior SF-36 scores were obtained for DTO compared to TA. The fact that the Japanese lifestyle involves tatami mats was thought to have contributed to the superiority of DTO in patient satisfaction.

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