Joint-Preserving Surgery in Varus Ankle Osteoarthritis

Abstract

Ankle deformity is a disabling condition especially if concomitant with osteoarthritis (OA). Varus ankle OA is one of the most common ankle OA deformities. This deformity usually leads to unequal load distribution in the ankle joint and decreases joint contact surface area, leading to a progressive degenerative arthritic situation. Varus ankle OA might have multiple causative factors, which might present as a single isolated factor or encompassed together in a single patient. The etiologies can be classified as post-traumatic (e.g., after fractures and lateral ligament instability), degenerative, systemic, neuromuscular, congenital, and others. Treatment options are determined by the degree of the deformity and analyzing the pathology, which range from the conservative treatments up to surgical interventions. Surgical treatment of the varus ankle OA can be classified into two categories, joint-preserving surgery (JPS) and joint-sacrificing surgery (JSS) as total ankle arthroplasty and ankle arthrodesis. JPS is a valuable treatment option in varus ankle OA, which should not be neglected since it has showed a promising result, optimizing biomechanics and improving the survivorship of the ankle joint.

Effect of four combined procedures to achieve inframalleolar correction for advanced varus ankle arthritis

“…An immediate postoperative non-weight-bearing radiograph showed a TT improvement (figure 5). Similar to the postoperative treatment of SMO,9 11 weight-bearing was absolutely prohibited in a below-knee cast for 6 weeks followed by partial weight-bearing in a short leg brace for 6 weeks. Gradual full weight-bearing and sports activities were allowed from 3 months postoperatively.…”

“…Operative treatment aims to realign the ankle joint with correction of the varus deformity and to redistribute weight-bearing on the ankle. Supramalleolar osteotomy (SMO) is a useful and proven procedure 4–10. However, SMO is generally indicated for ankle arthritis with a small talar tilt (TT) based on previous studies showing that SMO could not induce a significant TT improvement but a lateral shift of the talus centre.…”

Comparison of the Usefulness of Computer-Assisted Three-Dimensional Analysis and Weight-Bearing Radiographs in Ankle Osteoarthritis

“… 9 14 15 16) The tibial lateral surface angle (TLS), which can be measured in ankle weight-bearing lateral radiography, is also used for the diagnosis of ankle OA. 9 16 17 18) In foot diseases, flatfoot associated with ankle OA is defined as a weight-bearing foot with an abnormally low or absent longitudinal arch and a valgus heel position. 19) Foot standing AP views can be used to measure the talo-1st metatarsal angle (AP-TFMA) and AP talocalcaneal angle (AP-TCA), which are both indicators of flat feet.…”

“…The Lat-TCA is widely used in children as a diagnostic parameter for clubfoot. 6 17 19 20 21 22) Finally, hindfoot alignment views can be used to check the hindfoot alignment angle (HAA) to diagnose heel valgus or varus. 18 20 23 24) These measurements are commonly used in the assessment of hind- and midfoot deformities.…”