Medial Malleolar Osteotomy for the Correction of Varus Deformity During Total Ankle Arthroplasty: Results in 15 Ankles

Abstract

Medial malleolar lengthening osteotomy is an easy technique for the realignment of the varus ankle at the time of total ankle arthroplasty, and served as an alternative to medial ligament release or lateral ligament reconstruction.

Osteotomies for Managing Varus and Valgus Malalignment with Total Ankle Replacement

“…8,9,[19][20][21][22][23][24][25][26] One cannot isolate many studies reporting on outcomes of TARs combined with osteotomies, as these procedures are part of the whole spectrum of surgery performed for ankles with greater than 10 coronal plane deformity. Doets and colleagues 20 reported on his series of 15 TARs in varus ankles, requiring a medial malleolar lengthening osteotomy.…”

“…2). 15,16,20 One other option for larger varus deformity is the "plafondplasty," described by Ryssman and Myerson. 15 The osteotomy is guided from the supramalleolar region to the plafond, and bone graft is used to lengthen the medial wall of the ankle.…”

“…[3][4][5][6][7][8][9] Some surgeons have, however, expanded the indications of TAR to include ankles with preoperative deformity of 15 or more, performing adjunctive procedures to correct coronal plane alignment and stability (eg, subtalar or triple arthrodesis, osteotomies, soft tissue releases, and ligament reconstructions). [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] We present the rationale, surgical techniques, and outcomes of re-alignment osteotomies that have been described (ie, medial malleolus, fibula, distal or proximal tibia, calcaneus, first metatarsal) as adjunctive procedures performing TAR for deformed ankles. This article focuses on coronal plane deformities, but one has to bear in mind that ankle deformity rarely occurs in one plane only.…”

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

“…Good results have, however, recently been reported following TAR in patients with a hindfoot deformity of up to 30°. 16 Although many additional procedures are known, only a few series have included the results of TAR performed with additional operations 8,17,18 Hintermann et al 8 carried out 43 additional procedures simultaneously with 122 TARs using the Hintegra prosthesis, and had a good or excellent result in 82% and a revision rate of 6.6% after a mean of 18.9 months. In a follow-up study, including 271 cases with a mean follow-up of 36 months, the revision rate was 14.4%.…”

“…In a follow-up study, including 271 cases with a mean follow-up of 36 months, the revision rate was 14.4%. 18 Doets et al 17 developed a lengthening osteotomy of the medial malleolus and reported 12 excellent or good results in 14 ankles followed for more than two years. However, if they failed to correct the hindfoot varus deformity at the time of TAR, a revision procedure was required.…”