Supramalleolar Osteotomy With or Without Fibular Osteotomy for Varus Ankle Arthritis

Zhao, Hongmou; Liang, Xiaojun; Li, Yi; Liu, Hongliang; Wang, Junhu; Cheng, Long

doi:10.1177/1071100716649926

Cited by 48 publications

(63 citation statements)

References 43 publications

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“…There are numerous reports on supramalleolar osteotomy with or without fibular osteotomy for varus ankle arthritis. Hongmou et al [25] reported that fibular osteotomy may be necessary in supramalleolar osteotomy cases with a large talar tilt and small tibiocrural angles. Stufkens et al [26] also reported that only supramalleolar osteotomy with fibular osteotomy shifts the pressure laterally for varus ankle arthritis.…”

Section: Discussionmentioning

confidence: 99%

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

Nozaka

Miyakoshi

Kashiwagura

et al. 2020

BMC Musculoskelet Disord

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Background: In highly active older individuals, end-stage ankle osteoarthritis has traditionally been treated using tibiotalar arthrodesis, which provides considerable pain relief. 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 is a type of joint preservation surgery that 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 for treating ankle osteoarthritis. Methods: A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed, followed by angled osteotomy and correction of the distal tibia; the ankle joint was then stabilized after its condition improved. An external fixator was used in all patients, and joint distraction of approximately 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery. Results: The anteroposterior and lateral mortise angle during weight-bearing, talar tilt angle, and anterior translation of the talus on ankle stress radiography were improved significantly (P < 0.05). Signal changes on magnetic resonance imaging also improved in all patients. Visual analog scale and American Orthopedic Foot & Ankle Society scores improved significantly (P < 0.05), and no severe complications were observed. Conclusion: DTO with joint distraction may be useful as a joint-preserving surgery for medial ankle osteoarthritis in older patients with high levels of physical activity. Level of evidence: Level IV, retrospective case series.

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Section: Discussionmentioning

confidence: 99%

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

Nozaka

Miyakoshi

Kashiwagura

et al. 2020

BMC Musculoskelet Disord

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“…Moreover, allografts are often not commercially available in some countries owing to the high costs, lack of approval for use, or religious reasons (29). Therefore, alternative graft substances, such as coralline hydroxyapatite (18), interconnected porous calcium hydroxyapatite ceramic (23,24), and TCP (10,22,24), have been developed and used in various foot and ankle surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…However, in 2006, van der Krans et al (10) observed nonunion after using a tricalcium phosphate (TCP) block in an adult male weighing 110 kg. Although bone graft substitutes have been successfully used in around-the-knee osteotomies (19)(20)(21), few foot and ankle surgeons recognized their value as block bone grafts until the mid-2010s because of the graft's structural fragility (10,18,22).…”

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confidence: 99%

Calcaneocuboid Distraction Arthrodesis With Synthetic Bone Grafts: Preliminary Results of an Innovative Bone Grafting Procedure in 13 Patients

Kobayashi

Kageyama

Shido

2017

The Journal of Foot and Ankle Surgery

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Calcaneocuboid distraction arthrodesis (CCDA) is regarded as an effective method for reconstructing adult-acquired flatfoot deformity. In the present study, we present our experience with newly developed rigid β-tricalcium phosphate wedges to treat CCDA to better understand the outcomes of this synthetic bone grafting procedure. A total of 13 feet in 13 patients underwent CCDA with synthetic bone grafts. One male (7.69%) and 12 females (92.31%), with a mean age of 65.07 ± 11.83 (range 36 to 77) years, were followed up for a mean duration of 32.76 ± 12.81 (range 18 to 55) months. Successful graft union was postoperatively obtained in 12 of the 13 feet (92.31%). The mean preoperative visual analog scale and American Orthopaedic Foot and Ankle Society scale score were 7.97 ± 1.52 (range 5.4 to 10) and 54.46 ± 14.72 (range 18 to 75), respectively. These scores improved to 1.52 ± 1.78 (range 0 to 6.2) and 85.46 ± 13.38 (range 50 to 97) postoperatively (p = .001 for both comparisons). On radiographic analysis, the talonavicular coverage angle, first metatarsal talar angle, calcaneal pitch, and heel alignment angle had significantly improved (p = .001, p = .028, p = .006, and p = .001, respectively). The use of bone graft substitutes in CCDA is a viable treatment option for reconstructing flexible flatfoot deformity. Although good clinical and radiographic outcomes were obtained, our method is even more challenging than conventional methods and should be used with caution. Rigid locking fixation with a long period of protected weightbearing is highly recommended to attain uneventful bone healing.

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“…Supramalleolar osteotomy (SMOT) is an effective procedure for the treatment of midstage asymmetric ankle osteoarthritis [1][2][3][4]. Related studies have proved that the key factors affecting the postoperative curative effect of SMOT are the postoperative ankle Takakura stage [5], lower limb power line [6] and ankle angles [7]; but SMOT uses conventional operation (CO) method often does not perfectly accomplish these surgical aims leading to some patients have unsatisfactory outcomes [8,9]. The reasons include preoperative planning dependence on freehand drawing, and surgeons determine the operative procedure all depend on the surgeon's experiences and fluoroscopies [10].…”

Section: Introductionmentioning

confidence: 99%

Simulated operation combines patient-specific guide technology is superior to conventional technology for supramalleolar osteotomy: a retrospective comparative study

Wang

et al. 2020

Preprint

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Background: Over the past seven years, our team has designed a simulated operation combines patient-specific guide (SO-PSI) assisted supramalleolar osteotomy (SMOT) method and applied it to the clinic. This study aimed to determine the difference between SO-PSI technology and conventional operation (CO) technology for SMOT in preoperative planning, intraoperative application and postoperative curative effect. Methods: We retrospectively analyzed the data of SMOT in our hospital between October 2014 and December 2018; 28 patients were enrolled and divided into CO group (n=17) and SO-PSI group (n=11); the mean follow-up time was 33.4 (range, 13 to 59) months. We analyzed and compared perioperative data, accuracy of preoperative planning and intraoperative application, difference between pre- and post-operative of radiologic ankle angles, and change of AOFAS score, VAS, range of motion of ankle and Takakura stage after operation. Then we performed statistical analyses. Results: All ankle alignments and positions of two groups have been recovered. Compared with CO group, SO-PSI group has a shorter operative time and a postoperative hospital stay, a decreased number of fluoroscopies and a reduction of albumin, a longer preoperative planning time and a preoperative hospital stay and an increased hospitalization expenses. In SO-PSI group, the ankle angles between preoperative planning and postoperative shown good correlation, but not in CO group; the mean tibial ankle center discrepancy of SO-PSI group was 1.86±1.06 mm. After follow-up, all radiologic parameters of two groups significantly improved, but the improvement of tibial anterior surface angle and tibiotalar tilt angle of SO-PSI group were more obvious than that of CO group; AOFAS score, VAS, range of motion of ankle and Takakura stage of two groups improved after operation; but overall the improvements of SO-PSI group were better than the CO group. Conclusions: SO-PSI technology can carry out the preoperative plan accurately and quickly in SMOT; In general, compared with the conventional technology, SO-PSI technology has advantages in preoperative planning, intraoperative application and postoperative curative effect. Keywords: Supramalleolar osteotomy; Simulated operation; Patient-specific guide; Accuracy of preoperative planning; Practicability of application

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Supramalleolar Osteotomy With or Without Fibular Osteotomy for Varus Ankle Arthritis

Abstract: Level III, retrospective comparative study.

Cited by 48 publications

References 43 publications

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

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

Calcaneocuboid Distraction Arthrodesis With Synthetic Bone Grafts: Preliminary Results of an Innovative Bone Grafting Procedure in 13 Patients

Simulated operation combines patient-specific guide technology is superior to conventional technology for supramalleolar osteotomy: a retrospective comparative study

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