Osteotomies for Managing Varus and Valgus Malalignment with Total Ankle Replacement

Gougoulias, Nikolaos; Maffulli, Nicola

doi:10.1016/j.cpm.2015.06.014

Cited by 8 publications

(1 citation statement)

References 31 publications

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“…Realignment surgery, which is based on the theory that uneven pressure on the articular surface of the lower extremities may induce degeneration [ 3 ], is used to redistribute the joint weight-bearing pressure to delay the progression of osteoarthritis. The midterm results of SMOT showed good outcomes for pain relief, functional improvements, and returning to sports and recreation activities [ 7 – 12 , 15 – 19 , 21 , 23 , 27 , 28 ]. However, SMOT is still controversial, the indications for this procedure are still unclear, and the evidence is limited.…”

Section: Discussionmentioning

confidence: 99%

Fibular osteotomy is helpful for talar reduction in the treatment of varus ankle osteoarthritis with supramalleolar osteotomy

et al. 2021

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Background There have been debates on the necessity of fibular osteotomy (FO) in supramalleolar osteotomy (SMOT) for the treatment of varus ankle osteoarthritis. The purpose of the current study was to compare the clinical and radiological outcomes between SMOT with and without FO in the treatment of varus ankle osteoarthritis. Methods The SMOT group included 39 patients, and the SMOT with FO group included 24 patients. The basic information reached no significant difference between groups. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS), modified Takakura stage and range of motion (ROM) were used for the functional evaluation. The radiologic parameters were assessed at the last follow-up to compare the degree of talar reduction between the two groups. Results Both groups achieved significant improvements in AOFAS scores, modified Takakura stage, as well as AOS pain and functional scores (P < 0.001). The ROM of the ankle joint in the SMOT group was significantly decreased (P = 0.022). In both groups, all of the radiological parameters were significantly improved (P < 0.01). The tibiofibular clear space (TFCS) was significantly widened in the SMOT group (P < 0.001). No significant difference was found between the two groups according to the functional outcomes. However, the talar tilt angle (TT) and hindfoot alignment angle (HFA) in the SMOT with FO group were significantly smaller than those in the SMOT group (P < 0.05). The TFCS was significantly widened in the SMOT group (P = 0.001). The medial displacement of the talus (MDT) was better reduced in the SMOT with FO group (P = 0.006). Conclusion SMOT is a promising procedure for functional improvement and malalignment correction in varus ankle osteoarthritis but reduces ankle range of motion. If SMOT is combined with FO, talar tilt and medial displacement will be better reduced.

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