Realignment Surgery as Alternative Treatment of Varus and Valgus Ankle Osteoarthritis

Abstract

In patients with asymmetric (varus or valgus) ankle osteoarthritis, realignment surgery is an alternative treatment to fusion or total ankle replacement in selected cases. To determine whether realignment surgery in asymmetric ankle osteoarthritis relieved pain and improved function, we clinically and radiographically followed 35 consecutive patients with posttraumatic ankle osteoarthritis treated with lower leg and hindfoot realignment surgery. We further questioned if outcome correlated with achieved alignment. The average patient age was 43 years (range, 26-68 years). We used a standardized clinical and radiographic protocol. Besides distal tibial osteotomies, additional bony and soft tissue procedures were performed in 32 patients (91%). At mean followup of 5 years (range, 3-10.5 years), pain decreased by an average of 4 points on a visual analog scale; range of ankle motion increased by an average of 5 degrees . Walking ability and the functional parts of the American Foot and Ankle Society score increased by an average of 10 and 21 points, respectively, and correlated with achieved reversal of tibiotalar tilt and the score of Takakura et al. Revision surgery was performed in 10 ankles (29%), of which three ankles (9%) were converted to total ankle replacement. We believe the data support realignment surgery for patients with asymmetric ankle osteoarthritis.

Single-Stage Supramalleolar Osteotomy for Coronal Plane Deformity

“…Pagenstert et al [43] described detailed treatment algorithm of realignment surgery as alternative treatment in patients with varus or valgus ankle osteoarthritis. In total, 35 consecutive patients were included into this clinical and radiographic study with a mean follow-up of 5 years.…”

“…Revision surgery was necessary in 10 ankles including 3 conversions to total ankle replacement [43].…”

“…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…”

Radiographic Predictability of Cartilage Damage in Medial Ankle Osteoarthritis

“…Grading of ankle OA has not been evaluated critically in the early stages possibly because most patients with OA of the ankle are treated at a late stage with arthrodesis or total ankle arthroplasty. However, newer joint-sparing treatment options [9,40,50] for mid-stage OA more likely need radiographic staging closely correlated with cartilage changes to determine whether a particular procedure is reasonable. Several such grading systems have been described: those of Kellgren and Lawrence [28], van Dijk et al [52], Takakura et al [48], and a modified version of the Takakura et al system by Pagenstert et al [40].…”

Motion Versus Fixed Distraction of the Joint in the Treatment of Ankle Osteoarthritis

“…Osteoarthritis generally progresses over time, and, as with other major lower extremity joints, the treatment of choice for end-stage ankle osteoarthritis is surgical. In young patients, debridement, resurfacing, and realignment have limited indications [2][3][4][5] . Ankle arthrodesis and ankle replacement, currently the most commonly performed procedures, have recognized potential complications and long-term problems [6][7][8][9][10][11][12] .…”