Indications for Supramalleolar Osteotomy in Patients with Ankle Osteoarthritis and Varus Deformity

Lee, Woo-Chun; Moon, Jeong Seok; Lee, Kang; Byun, Woo Jin; Lee, Sang Hyeong

doi:10.2106/jbjs.j.00249

Cited by 151 publications

(205 citation statements)

References 13 publications

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“…Lee et al [41] reported their results in 16 ankles treated with supramalleolar osteotomy combined with fibula osteotomy because of moderate medial ankle osteoarthritis. At the mean follow-up of 2.3 years, substantial functional improvement including AOFAS hindfoot score was observed.…”

Section: Clinical Results Following Supramalleolar Osteotomiesmentioning

confidence: 99%

“…All radiographic parameters also improved significantly after realignment surgery. The authors have identified that the supramalleolar osteotomy has the best clinical outcome in patients with moderate talar tilt (less than 7.3°) and neutral or varus heel alignment [41]. [37] IV 9 (9 ankles) Six-axis deformity correction using Taylor spatial frame external fixator (9) Superficial pin site infections (2; 22.2 %), delayed union Knupp et al [40] reported their results of realignment surgery in 14 patients treated between 2002 and 2009 because of overcorrected clubfoot deformity.…”

Section: Clinical Results Following Supramalleolar Osteotomiesmentioning

confidence: 99%

“…There is no evidence-based literature addressing the limits of degree and extension of degenerative changes in the tibiotalar joint. General recommendations are at least 50 % preserved tibiotalar joint surface [28,41,[47][48][49]. In patients with isolated osteochondral lesions of the medial or lateral compartment of the tibiotalar joint with concomitant supramalleolar valgus or varus deformity, supramalleolar osteotomies should be performed before chondral or osteochondral reconstruction of local ankle degeneration [10,50,51].…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

“…In theory, for some deformities, a well-designed and executed single osteotomy with (5), intra-articular medial opening wedge OT (7), fibula OT in 14 cases Colin et al [35] 2014 Post-traumatic OA with varus (62) or valgus (21) deformity lateral closing-wedge OT (41), medial opening-wedge OT (21), medial closing-wedge OT (12), lateral opening-wedge OT (9) Ellington and Myerson [36] 2013 Secondary (9) OA with ball and socket ankle SM medial closing-wedge OT (9) Gessmann et al [37] 2009 Post-traumatic (8) OA, malunited ankle arthrodesis (1) six-axis deformity correction using Taylor spatial frame external fixator (9) Harstall et al [38] 2007 Post-traumatic (8) OA, post childhood osteomyelitis (1) SM lateral closing-wedge OT (9) Hintermann et al [39] 2011 Post-traumatic (48) OA medial closing-wedge OT (45), lateral opening-wedge OT in combination with intra-articular OT (3) Knupp et al [40] 2012 Secondary (14) OA (overcorrected clubfoot) with valgus deformity SM medial closing-wedge OT (14) Lee et al [41] 2011 Primary (8) and post-traumatic (ligamentous) (8) OA with varus deformity SM medial opening-wedge OT with fibular OT (16) Neumann et al [42] 2007 Primary (18), post-traumatic (7), and secondary OA because of clubfoot deformity with varus deformity (2) SM lateral closing-wedge OT (27) Pagenstert et al [43] 2007 Post-traumatic (35) OA with varus (13) or valgus (22) deformity…”

Section: Preoperative Planningmentioning

confidence: 99%

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Single-Stage Supramalleolar Osteotomy for Coronal Plane Deformity

Barg

Saltzman

2014

Curr Rev Musculoskelet Med

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A variety of surgical procedures are utilized for management of ankle osteoarthritis. The most common etiology in patients with ankle osteoarthritis is post-traumatic often resulting in asymmetric ankle osteoarthritis with concomitant valgus or varus deformity. A substantial part of tibiotalar joint is often preserved, therefore, in appropriate patients, jointpreserving surgery holds the potential to be a superior treatment option than joint-sacrificing procedures including total ankle replacement or ankle arthrodesis. This review is designed to describe indications and contraindications for single-stage supramalleolar realignment surgery. Complications associated with this type of surgery and postoperative outcome are highlighted using recent literature.

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Section: Clinical Results Following Supramalleolar Osteotomiesmentioning

confidence: 99%

Section: Clinical Results Following Supramalleolar Osteotomiesmentioning

confidence: 99%

Section: Indications and Contraindicationsmentioning

confidence: 99%

Section: Preoperative Planningmentioning

confidence: 99%

See 2 more Smart Citations

Single-Stage Supramalleolar Osteotomy for Coronal Plane Deformity

Barg

Saltzman

2014

Curr Rev Musculoskelet Med

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“…Surgical realignment procedures can help restore joint function and prevent further progression of asymmetric ankle arthritis [46][47][48][49][50][51][52]. It allows redistribution of the abnormal weight bearing axis on the ankle joint to unload the diseased joint area.…”

Section: Realignment Proceduresmentioning

confidence: 99%

Ankle Arthritis: An Evolution from Arthrodesis to Joint and Mobility Preservation

Tan¹

2013

Orthop Muscul Syst

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Ankle arthritis is a debilitating condition. It can disrupt physical function and quality of life. Non surgical treatment includes pharmacological agents and orthoses. Surgical options range from arthrodesis to joint preservation techniques. Ankle arthrodesis is a reliable and effective treatment of choice for advanced ankle arthritis but has its limitations. Total ankle arthroplasty is fast gaining renewed interest as longer term outcome studies show good results coupled with improved implant and instrumentation designs. Osteotomies and arthroscopic debridement are increasingly popular techniques that are useful for joint preservation. Joint distraction arthroplasty and osteochondral allografting are also showing some promise. This article reviews the impact of ankle arthritis and treatment strategies available from joint sacrificing surgery to joint and mobility preservation.

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The utility of the ankle SPECT/CT scan to predict functional and clinical outcomes in supramalleolar osteotomy patients

Gross

Barfield

Schweizer

et al. 2018

Journal Orthopaedic Research

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Combined single-photon emission computed tomography and conventional computed tomography (SPECT/CT) is a hybrid imaging modality that shows a combination of metabolic and structural information about the ankle, including arthritis. We hypothesize that uptake in specific locations within the ankle joint can be associated with both clinical outcomes and may help predict which patients will have a successful SMO. Eighty-five pre-operative SMO patients with varus (37), valgus (41), or neutral (7) alignment of the hindfoot were assessed using SPECT/CT. The level of activation on SPECT/CT scans was measured. Pre and Post-operative functional scores were recorded. Patients with medial gutter activation had significantly worse (p < 0.05) AOFAS alignment (AOFAS-A) scores pre-operatively. Patients with varus or valgus alignment did not have any difference in VAS pain scores, but those in valgus did have worse AOFAS-P (pain) scores. Those with cystic lesions had a worse FAOS score pre-operatively. Ten patients (12.5%) had a treatment failure. Pre or post-operative alignment did not correlate to a treatment failure. The only statistically significant (p = 0.036) poor prognostic indicator was a bipolar lesion. Pre-operative SPECT/CT evaluation of an ankle before a SMO can be used to clinically correlate patient-specific factors such as pain and function in the pre and post-operative period. We caution against performing a SMO in patients with bipolar activation on a pre-operative SPECT-CT scan. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2015-2021, 2018.

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Indications for Supramalleolar Osteotomy in Patients with Ankle Osteoarthritis and Varus Deformity

Abstract: Supramalleolar osteotomy is indicated for the treatment of ankle osteoarthritis in patients with minimal talar tilt and neutral or varus heel alignment.

Cited by 151 publications

References 13 publications

Single-Stage Supramalleolar Osteotomy for Coronal Plane Deformity

Single-Stage Supramalleolar Osteotomy for Coronal Plane Deformity

Ankle Arthritis: An Evolution from Arthrodesis to Joint and Mobility Preservation

The utility of the ankle SPECT/CT scan to predict functional and clinical outcomes in supramalleolar osteotomy patients

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