Fibular osteotomy is helpful for talar reduction in the treatment of varus ankle osteoarthritis with supramalleolar osteotomy

Abstract

Background There have been debates on the necessity of fibular osteotomy (FO) in supramalleolar osteotomy (SMOT) for the treatment of varus ankle osteoarthritis. The purpose of the current study was to compare the clinical and radiological outcomes between SMOT with and without FO in the treatment of varus ankle osteoarthritis. Methods The SMOT group included 39 patients, and the SMOT with FO group included 24 patients. The basic information reached no significant difference between groups. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS), modified Takakura stage and range of motion (ROM) were used for the functional evaluation. The radiologic parameters were assessed at the last follow-up to compare the degree of talar reduction between the two groups. Results Both groups achieved significant improvements in AOFAS scores, modified Takakura stage, as well as AOS pain and functional scores (P < 0.001). The ROM of the ankle joint in the SMOT group was significantly decreased (P = 0.022). In both groups, all of the radiological parameters were significantly improved (P < 0.01). The tibiofibular clear space (TFCS) was significantly widened in the SMOT group (P < 0.001). No significant difference was found between the two groups according to the functional outcomes. However, the talar tilt angle (TT) and hindfoot alignment angle (HFA) in the SMOT with FO group were significantly smaller than those in the SMOT group (P < 0.05). The TFCS was significantly widened in the SMOT group (P = 0.001). The medial displacement of the talus (MDT) was better reduced in the SMOT with FO group (P = 0.006). Conclusion SMOT is a promising procedure for functional improvement and malalignment correction in varus ankle osteoarthritis but reduces ankle range of motion. If SMOT is combined with FO, talar tilt and medial displacement will be better reduced.

Supramalleolar Osteotomy vs Arthrodesis for the Treatment of Takakura 3B Ankle Osteoarthritis

“…Our group has previ ously reported that the addition of medial distraction is helpful for the correction of increased talar tilt. 20,36 In the present SMOT cohort, patients with TT larger than 10 degrees had medial distraction. They appeared to do well, but further study is needed to verify this approach.…”

“…The indication and techniques of these additional procedures were described in our previous studies. 20,35,36 Also, we used medial distraction arthroplasty in 13 cases with preoperative TT angle larger than 10 degrees. The same senior surgeons performed the AA pro cedures.…”

“…Some authors have reported that SMOT for stage 3B varus ankle OA is associated with high failure rate, 17,30 but some have reported positive outcomes. 4,20,24 33,36 . Currently, SMOT, total ankle replacement (TAR), and ankle arthrodesis (AA) are the commonly used surgical procedures for the stage 3B ankle OA.…”

“…1,5,29 Supramalleolar osteotomy (SMOT) has been used for the midstaged ankle OA, and with satisfactory outcomes in treatment of stage 2 and stage 3A cases. 12,15,19,20,30 The treatment of stage 3B remains controversial. Some authors have reported that SMOT for stage 3B varus ankle OA is associated with high failure rate, 17,30 but some have reported positive outcomes.…”

Is there an optimal degree of correction for ankle varus deformity after supramalleolar osteotomy? A systematic review

“…Three o the 30 studies described two dierent patient cohorts in details that both met our inclusion criteria; Choi et al, 2021; patients 65 years o age or younger and patients older than 65 years [24]. Liang et al, 2021; patients treated with SMOT and patients treated with SMOT and bulotomy [37], Zhao et al, 2019; patients treated with SMOT and patients treated with SMOT and medial distraction arthroplasty (MDA) [42]. In total, 33 patient cohorts with 922 ankles were ound with a mean o 27.9 (SD 19.1) ankles (range 5 -99) per cohort.…”