Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients

Abstract

Primary osteoarthritis of the ankle with no history of trauma is rare. We report the use of a low tibial osteotomy on 18 ankles in 18 patients, two men and 16 women. The osteotomy is designed to correct the varus tilt and anterior opening of the distal tibial joint surface where it has been shown by weight-bearing radiographs and arthroscopy that there is healthy articular cartilage on the lateral side of the ankle. An opening-wedge osteotomy was used to achieve slight overcorrection. Follow-up of the 18 ankles at an average of 6 years 11 months (2.7 to 12.10) showed the results by our own scoring system to be excellent in six ankles, good in nine, and fair in three with no poor results. Of the three patients with fair results, two had been undercorrected and the third had little residual articular cartilage. Arthroscopic examination of ten ankles showed repair by fibrocartilage in seven. We conclude that slight overcorrection of deformity by low tibial osteotomy is effective in treating intermediate-stage primary osteoarthritis of the ankle.

Does the Subtalar Joint Compensate for Ankle Malalignment in End-stage Ankle Arthritis?

“…Takakura et al [29] speculated that the subtalar joint may have some ability to compensate because it may prevent the progression of ankle arthritis. They postulated that ankle arthritis may progress after the subtalar compensatory function is lost based on their observations of a relatively small cohort with end-stage ankle arthritis [29].…”

“…Takakura et al [29] speculated that the subtalar joint may have some ability to compensate because it may prevent the progression of ankle arthritis. They postulated that ankle arthritis may progress after the subtalar compensatory function is lost based on their observations of a relatively small cohort with end-stage ankle arthritis [29]. Hayashi et al [12] documented subtalar joint inclination at the various arthritis stages by measuring the angle between the tibial shaft axis and the articular surface of the posterior facet of the calcaneus.…”

Treatment of osteochondral defects of the talus

“…Several radiographic grading systems have been developed for the osteoarthritic ankle joint 211,375,425 . Th e scales focus on the presence of osteophytes and joint space narrowing.…”

“…The Kellgren and Lawrence system was not designed specifically for the ankle 211 . The Takakura system focuses mainly on the medial joint space 375 . The van Dijk OA classification evaluates the complete talocrural joint, and has been used for the evaluation of talar OCD 346,416 .…”

Total ankle replacement in moderate to severe varus deformity of the ankle

“…There were more male patients in the varus group and more female patients in the neutral group (p < 0.05; Table I). According to the classification of Takakura et al, 12 most of the varus ankles were in stage 3 while the neutral ankles were mostly in stage 4 (p < 0.05; patients were satisfied, two (cases 6 and 14) were somewhat satisfied and one (case 8) was not satisfied, complaining of pain around the lateral malleolus where transfer of the tendon of peroneus longus and a modified Broström procedure had been performed. When the congruent and incongruent varus groups were compared, the results were also similar.…”