Modified distal tibial oblique osteotomy for osteoarthritis of the ankle: Operative procedure and preliminary results

Watanabe, Kota; Teramoto, Atsushi; Kobayashi, Takuma; Sakakibara, Yuzuru; Shoji, Hirokazu; Okimura, Shinichiro; Nuka, Satoshi; Yamashita, Toshihiko

doi:10.1016/j.jos.2018.08.020

Cited by 4 publications

(5 citation statements)

References 15 publications

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“…DTOO is a corrective osteotomy for ankle osteoarthritis designed to stabilize the tibiotalar joint, increase CA, and redistribute joint CP to relieve pain and improve ankle function [4][5][6]. Although clinical studies have shown promising results [6][7][8], biomechanical evidence supporting the efficacy of DTOO is lacking. Using patient-specific FE models, the current study demonstrated for the first time that DTOO effectively improved the biomechanics of ankle osteoarthritis, as indicated by increased CA and redistribution of CP.…”

Section: Discussionmentioning

confidence: 99%

“…Distal tibial oblique osteotomy (DTOO) serves as a corrective osteotomy for varus osteoarthritis with the goal of stabilizing the tibiotalar joint, increasing the contact area (CA), and redistributing joint contact pressure (CP) to relieve pain and improve ankle function [4][5][6]. Despite encouraging clinical results [6][7][8], no study has validated the biomechanical improvements in the ankle after DTOO. Furthermore, there exists a lack of concrete evidence to direct the surgical indications for DTOO or to establish an association between morphological correction and treatment efficacy, leaving the decision largely at the discretion of the surgeon.…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical Effect of Distal Tibial Oblique Osteotomy: A Preliminary Finite-Element Analysis

Sakai,

Fujii,

Kitamura

et al. 2024

Cureus

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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 mm 2 and the maximum CP was 2.6 MPa. In case 1, the CA increased by 125% from 166 mm 2 preoperatively to 375 mm 2 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 mm 2 to 439 mm 2 , 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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Biomechanical Effect of Distal Tibial Oblique Osteotomy: A Preliminary Finite-Element Analysis

Sakai,

Fujii,

Kitamura

et al. 2024

Cureus

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“…We classied the 33 patient cohorts according to the obtained MDTA described at ollow-up as shown in Table 2; 7 cohorts [13,22,[24][25][26][27]38] categorized in valgus overcorrection (mean correction o 11 degrees), 9 cohorts [12,14,23,24,28,[32][33][34]36] in valgus correction (mean correction o 9 degrees), 10 cohorts [11,16,[29][30][31]35,[39][40][41]45] in neutral correction (mean correction o 8 degrees), 6 cohorts (4 studies) [4,37,42,43] in varus correction (mean correction o 8 degrees), and 1 cohort [44] in varus overcorrection (mean correction o 4 degrees). At baseline the 5 categories had a mean ankle OA stage o 3 and a comparable mean preoperative MDTA o 82-85 degrees.…”

Section: Discussionmentioning

confidence: 99%

“…In our included studies [12,16,34,39] patient characteristics and outcomes were described individually. For analysis o the relationship between the obtained correction and clinical outcome a total o 34 patients were identied (Table 3).…”

Section: Individual Patient Datamentioning

confidence: 99%

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

Beijk

Johannes

et al. 2022

Foot and Ankle Surgery

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“…Watanabe et al found that a potential concern with tibial open-wedge osteotomies, especially DTOO, is soft tissue or skin complications due to excessive tension following the displacement of the osteotomized distal tibial fragment, including severe problems such as infection and bone nonunion. 9 The correction angle may be insufficient to avoid skin and subcutaneous problems. Teramoto et al have noted that if there is no previous scarring of the medial skin, and the osteotomy separation is less than 15 mm, a locking plate can be inserted without removing the medial tibial cortex and cancellous bone.…”

Section: Brief Introductionmentioning

confidence: 99%

Early results of intramedullary nail fixation in distal tibia oblique osteotomy for the reduction of soft tissue complications

Morohashi

Mogami

Wakeshima

et al. 2023

J Orthop Surg (Hong Kong)

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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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Modified distal tibial oblique osteotomy for osteoarthritis of the ankle: Operative procedure and preliminary results

Cited by 4 publications

References 15 publications

Biomechanical Effect of Distal Tibial Oblique Osteotomy: A Preliminary Finite-Element Analysis

Biomechanical Effect of Distal Tibial Oblique Osteotomy: A Preliminary Finite-Element Analysis

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

Early results of intramedullary nail fixation in distal tibia oblique osteotomy for the reduction of soft tissue complications

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