The role of fibular for supramalleolar osteotomy in treatment of varus ankle arthritis: a biomechanical and clinical study

Abstract

BackgroundSupramalleolar osteotomy (SMOT) is a well-accepted treatment method for mid-stage varus ankle osteoarthritis (OA). However, few studies have examined the role of fibular osteotomy in SMOT. The objective of the current study was to compare the biomechanical and clinical outcomes of SMOT with and without fibular osteotomy.MethodsEight cadaveric lower legs with 10° varus/valgus SMOT models were tested using a Tekscan ankle sensor. Tibiotalar joint contact with and without fibular osteotomy conditions were compared. Forty-one varus ankle OA patients treated with SMOT were included; 22 underwent fibular osteotomy, and 19 did not. The Maryland foot score and radiological angles were used for clinical evaluation.ResultsThe mean contact area and pressure did not differ significantly between normal and varus/valgus conditions with the fibula preserved. After fibular osteotomy, the mean contact area decreased and the mean contact pressure increased significantly in varus and valgus conditions (P < 0.01). The loading center moved to the opposite direction with and without fibular osteotomy in varus/valgus conditions. After a mean follow-up of 36.6 months (range 17–61), there was no significant difference in the Maryland scores of the two groups. However, in the fibular osteotomy group, the talar tilt angle decreased (P < 0.05), and the tibiocrural angle improved significantly (P < 0.01).ConclusionsFibular osteotomy facilitates the translation of tibiotalar contact pressure and is helpful for varus ankle realignment in patients with large talar tilts and small tibiocrural angles.

Simulated operation combines patient-specific guide technology is superior to conventional technology for supramalleolar osteotomy: a retrospective comparative study

“…(2) Still consistent with similar studies, the surgeon has performed repeated simulated operations on a digital model before surgery, they must to face difficulties and detail ready prepared ahead of time; at this time the feasibility and perfectness of the preoperative planning are preferable because it is well thought out [24]. (3) Compared with conventional technology, the use of PSI in operation can make the traditional osteotomy and alignment process faster and more accurate; relevant studies have shown that PSI can reduce the number of surgical procedures and fluoroscopies during the operation, and with the help of PSI, many procedures no longer require repeated attempts [11]. (4) Another possible reason is that our team's rich digital orthopedic operation experience [12] provides this new technology with good personnel, technical reserves and execution ability.…”

“…Supramalleolar osteotomy (SMOT) is an effective procedure for the treatment of midstage asymmetric ankle osteoarthritis [1][2][3][4]. Related studies have proved that the key factors affecting the postoperative curative effect of SMOT are the postoperative ankle Takakura stage [5], lower limb power line [6] and ankle angles [7]; but SMOT uses conventional operation (CO) method often does not perfectly accomplish these surgical aims leading to some patients have unsatisfactory outcomes [8,9].…”

Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

“…The surgical treatment of ankle osteoarthritis varies according to the stage. In patients with stage II and IIIA ankle osteoarthritis, low tibial osteotomy (LTO) is indicated for correcting the alignment of the lower end of the tibia surface [1][2][3][4][5], whereas total ankle arthroplasty or arthrodesis is generally indicated for patients with end-stage arthropathy (stages IIIB and IV) [6][7][8][9]. Intraarticular deformities may also be treated with total ankle arthroplasty, and distraction arthroplasty is indicated for patients with stage III or IV arthropathy [10][11][12][13][14].…”

Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

“…The surgical treatment of ankle osteoarthritis varies according to the stage. In patients with stage II and IIIA ankle osteoarthritis, low tibial osteotomy (LTO) is indicated for correcting the alignment of the lower end of the tibia surface [1][2][3][4][5], whereas total ankle arthroplasty or arthrodesis is generally indicated for patients with end-stage arthropathy (stages IIIB and IV) [6][7][8][9].…”