Ankle Pain After Medial Opening-Wedge High Tibial Osteotomy in Patients With Knee Osteoarthritis and Concurrent Ankle Osteoarthritis

Abstract

Background: Medial opening-wedge high tibial osteotomy (MOWHTO) in patients with varus knee osteoarthritis (OA) causes changes to ankle and hindfoot alignment. However, the compensatory ability of the ankle and hindfoot varies according to the severity of ankle OA. Purpose: To investigate whether the changes in ankle symptoms and ankle and hindfoot alignments differ after MOWHTO according to the severity of preoperative ankle OA. Study design: Case-control study; Level of evidence, 3. Methods: The data of 130 patients who were followed for ≥4 years were reviewed. Patients were classified into 2 groups according to their severity of ankle OA: group 1, modified Kellgren-Lawrence grade 0 and 1; group 2, grade ≥2. Four radiographic parameters were examined to evaluate ankle alignment: tibial plafond inclination, talar tilt, talar inclination, and tibial surface angle. The hindfoot alignment was evaluated using the varus-valgus angle (VVA) of the calcaneus. A visual analog scale (VAS) was used to evaluate ankle pain. The patient-reported outcome measure of the knee joint was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Results: There were 110 patients in group 1 and 20 patients in group 2. In group 2, the change in talar inclination after MOWHTO was significantly greater and the changes in tibial plafond inclination, talar tilt, and VVA were significantly smaller compared with in group 1 (all P < .05). Ankle pain VAS scores were more severe in group 2 than in group 1 pre- and postoperatively (all P < .05), and group 2 reported that ankle pain worsened postoperatively ( P < .05). In both groups, knee WOMAC scores improved, and there were no differences between groups pre- or postoperatively (all P > .05). A multivariate regression analysis demonstrated that a small VVA change (odds ratio, 0.775; P = .027) and severe OA grade of the ankle joint preoperatively (Kellgren-Lawrence grades 2-4 vs 0 and 1; odds ratio, 4.241 [ P = .046]) predicted increased ankle pain VAS scores after MOWHTO. Conclusion: Although the patient-reported outcome measures for the knee joint improved irrespective of the presence of ankle OA, ankle pain worsened after MOWHTO in patients with ankle OA. Inadequate compensatory change in hindfoot alignment increased ankle pain in these patients.

Preoperative Hindfoot Alignment and Outcomes After High Tibial Osteotomy for Varus Knee Osteoarthritis

“…Thus, alignment changes of the lower limb resulting from high tibial osteotomy (HTO) may have a subsequent effect on hindfoot alignment [11][12][13] . However, despite its possible clinical effect on patient-reported outcome measures (PROMs) postoperatively, HTO has generally been performed without a careful evaluation of the subtalar joint 15,16 .…”

“…T H E J O U R N A L O F B O N E & JOINT SURGERY d J B J S . O R G VOLUME 106-A d NUMBER 10 d M AY15, 2024 …”

Investigating the prevalence and influential factors of ankle pain following total knee arthroplasty in patients with varus and valgus knee deformities

“…Some studies have also shown that the deformity in patients with knee varus after TKA surgery has been corrected, and the force line of the ankle joint has also changed. This change leads to ankle incompatibility, resulting in pain [15]. We hypothesise that ankle pain following total knee arthroplasty (TKA) in patients with varus or valgus deformity is not only associated with changes in knee joint alignment, but also in uenced by alterations in ankle joint alignment.…”