Supramalleolar osteotomy treatment of varus ankle osteoarthritis with or without fibular osteotomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Hongmou , ZHANG Yan , HU Dong , LI Yi ,  LIANG Xiaojun , LIU Cheng , WANG Junhu

Department of Foot and Ankle Surgery, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

LIANG Xiaojun, Email: liangxj33369@163.com

Keywords：

Ankle; osteoarthritis; supramalleolar osteotomy; fibular osteotomy

DOI：

10.7507/1002-1892.201611110

Video：

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Objective To compare the functional and radiological outcomes of supramalleolar osteotomy (SMOT) between with and without fibular osteotomy for varus ankle osteoarthritis. Methods Between April 2009 and April 2014, 41 patients (41 feet) with mid-staged varus ankle osteoarthritis were treated with SMOT. Fibular osteotomy was not performed in 19 cases (group A), and fibular osteotomy was performed in 22 cases (group B). There was no significant difference in gender, age, side, body mass index, osteoarthritis stage, pathogeny, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind score, ankle osteoarthritis scale (AOS) pain and function scores, range of motion (ROM) of the ankle joint, tibial articular surface angle (TAS), talar tilt angle (TT), tibiocrural angle (TC), and tibial lateral surface angle (TLS) between 2 groups (P>0.05). The bone union was observed after operation, and functional and radiological outcomes were compared between 2 groups at last follow-up. Results All incisions healed by stage I, and no surgery related complications occurred. The mean follow-up time was 36.6 months (range, 16-55 months). Pain and limited activity were observed in 1 case of groups A and B respectively, and ankle arthrodesis was performed. All cases achieved bony union; the bone union time was (3.6±0.4) months in group A and (3.9±0.7) months in group B, showing no significant difference (t=1.61,P=0.12). At last follow-up, no significant difference was found in TAS, TLS, TT, and TC between groups (P>0.05). However, group B was significantly better than group A in improvement of TT and TC (P<0.05). The AOFAS ankle-hind score, AOS pain and function scores, ROM of the ankle joint showed no significant difference between groups (P>0.05). According to the modified Takakura stage, the improvement rates of groups A and B were 55.6% and 57.1%, respectively; no significant difference was found between 2 groups (χ²=0.01,P=0.92). Conclusion SMOT with fibular osteotomy is helpful in correction of TT and TC in patients with relative longer fibula.

Citation： ZHAO Hongmou, ZHANG Yan, HU Dong, LI Yi, LIANG Xiaojun, LIU Cheng, WANG Junhu. Supramalleolar osteotomy treatment of varus ankle osteoarthritis with or without fibular osteotomy. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(3): 284-289. doi: 10.7507/1002-1892.201611110 Copy

1.	Horisberger M, Hintermann B, Valderrabano V. Alterations of plantar pressure distribution in posttraumatic end-stage ankle osteoarthritis. Clin Biomech (Bristol, Avon), 2009, 24(3): 303-307.
2.	Zhao H, Yang Y, Yu G,et al. A systematic review of outcome and failure rate of uncemented Scandinavian total ankle replacement. Int Orthop, 2011, 35(12): 1751-1758.
3.	武勇, 王岩, 王金辉, 等. 踝关节融合治疗创伤后踝关节炎. 中华骨科杂志, 2013, 33(4): 409-413.
4.	Ahn TK, Yi Y, Cho JH,et al. A cohort study of patients undergoing distal tibial osteotomy without fibular osteotomy for medial ankle arthritis with mortise widening. J Bone Joint Surg (Am), 2015, 97(5): 381-388.
5.	Cheng YM, Huang PJ, Hong SH,et al. Low tibial osteotomy for moderate ankle arthritis. Arch Orthop Trauma Surg, 2001, 121(6): 355-358.
6.	Colin F, Bolliger L, Horn Lang T,et al. Effect of supramalleolar osteotomy and total ankle replacement on talar position in the varus osteoarthritic ankle: a comparative study. Foot Ankle Int, 2014, 35(5): 445-452.
7.	Haraguchi N, Ota K, Tsunoda N,et al. Weight-bearing-line analysis in supramalleolar osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg (Am), 2015, 97(4): 333-339.
8.	Kim YS, Park EH, Koh YG,et al. Supramalleolar osteotomy with bone marrow stimulation for varus ankle osteoarthritis: clinical results and second-look arthroscopic evaluation. Am J Sports Med, 2014, 42(7): 1558-1566.
9.	Knupp M, Stufkens SA, Bolliger L,et al. Classification and treatment of supramalleolar deformities. Foot Ankle Int, 2011, 32(11): 1023-1031.
10.	Kobayashi H, Kageyama Y, Shido Y. Treatment of varus ankle osteoarthritis and Instability with a novel mortise-plasty osteotomy procedure. J Foot Ankle Surg, 2016, 55(1): 60-67.
11.	Lee WC, Moon JS, Lee K,et al. Indications for supramalleolar osteotomy in patients with ankle osteoarthritis and varus deformity. J Bone Joint Surg (Am), 2011, 93(13): 1243-1248.
12.	Nüesch C, Huber C, Paul J,et al. Mid- to long-term clinical outcome and gait biomechanics after realignment surgery in asymmetric ankle osteoarthritis. Foot Ankle Int, 2015, 36(8): 908-918.
13.	Pagenstert GI, Hintermann B, Barg A,et al. Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res, 2007, (462): 156-168.
14.	Stamatis ED, Cooper PS, Myerson MS. Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint. Foot Ankle Int, 2003, 24(10): 754-764.
15.	Takakura Y, Tanaka Y, Kumai T,et al. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg (Br), 1995, 77(1): 50-54.
16.	Tanaka Y, Takakura Y, Hayashi K,et al. Low tibial osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg (Br), 2006, 88(7): 909-913.
17.	Stufkens SA, van Bergen CJ, Blankevoort L,et al. The role of the fibula in varus and valgus deformity of the tibia: a biomechanical study. J Bone Joint Surg (Br), 2011, 93(9): 1232-1239.
18.	Barg A, Saltzman CL. Single-stage supramalleolar osteotomy for coronal plane deformity. Curr Rev Musculoskelet Med, 2014, 7(4): 277-291.
19.	胡永成, 邱贵兴, 马信龙, 等. 骨科疾病疗效评价标准. 北京: 人民卫生出版社, 2012: 231-267.
20.	赵宏谋, 梁晓军, 李毅, 等. 合并腓骨截骨的踝上截骨治疗内翻型踝关节炎. 中华骨科杂志, 2016, 36(16): 1025-1032.
21.	赵宏谋, 梁晓军, 李毅, 等. 胫骨远端内外翻畸形对胫距关节接触的影响. 中国修复重建外科杂志, 2016, 30(7): 826-829.

1. Horisberger M, Hintermann B, Valderrabano V. Alterations of plantar pressure distribution in posttraumatic end-stage ankle osteoarthritis. Clin Biomech (Bristol, Avon), 2009, 24(3): 303-307.
2. Zhao H, Yang Y, Yu G,et al. A systematic review of outcome and failure rate of uncemented Scandinavian total ankle replacement. Int Orthop, 2011, 35(12): 1751-1758.
3. 武勇, 王岩, 王金辉, 等. 踝关节融合治疗创伤后踝关节炎. 中华骨科杂志, 2013, 33(4): 409-413.
4. Ahn TK, Yi Y, Cho JH,et al. A cohort study of patients undergoing distal tibial osteotomy without fibular osteotomy for medial ankle arthritis with mortise widening. J Bone Joint Surg (Am), 2015, 97(5): 381-388.
5. Cheng YM, Huang PJ, Hong SH,et al. Low tibial osteotomy for moderate ankle arthritis. Arch Orthop Trauma Surg, 2001, 121(6): 355-358.
6. Colin F, Bolliger L, Horn Lang T,et al. Effect of supramalleolar osteotomy and total ankle replacement on talar position in the varus osteoarthritic ankle: a comparative study. Foot Ankle Int, 2014, 35(5): 445-452.
7. Haraguchi N, Ota K, Tsunoda N,et al. Weight-bearing-line analysis in supramalleolar osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg (Am), 2015, 97(4): 333-339.
8. Kim YS, Park EH, Koh YG,et al. Supramalleolar osteotomy with bone marrow stimulation for varus ankle osteoarthritis: clinical results and second-look arthroscopic evaluation. Am J Sports Med, 2014, 42(7): 1558-1566.
9. Knupp M, Stufkens SA, Bolliger L,et al. Classification and treatment of supramalleolar deformities. Foot Ankle Int, 2011, 32(11): 1023-1031.
10. Kobayashi H, Kageyama Y, Shido Y. Treatment of varus ankle osteoarthritis and Instability with a novel mortise-plasty osteotomy procedure. J Foot Ankle Surg, 2016, 55(1): 60-67.
11. Lee WC, Moon JS, Lee K,et al. Indications for supramalleolar osteotomy in patients with ankle osteoarthritis and varus deformity. J Bone Joint Surg (Am), 2011, 93(13): 1243-1248.
12. Nüesch C, Huber C, Paul J,et al. Mid- to long-term clinical outcome and gait biomechanics after realignment surgery in asymmetric ankle osteoarthritis. Foot Ankle Int, 2015, 36(8): 908-918.
13. Pagenstert GI, Hintermann B, Barg A,et al. Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res, 2007, (462): 156-168.
14. Stamatis ED, Cooper PS, Myerson MS. Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint. Foot Ankle Int, 2003, 24(10): 754-764.
15. Takakura Y, Tanaka Y, Kumai T,et al. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg (Br), 1995, 77(1): 50-54.
16. Tanaka Y, Takakura Y, Hayashi K,et al. Low tibial osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg (Br), 2006, 88(7): 909-913.
17. Stufkens SA, van Bergen CJ, Blankevoort L,et al. The role of the fibula in varus and valgus deformity of the tibia: a biomechanical study. J Bone Joint Surg (Br), 2011, 93(9): 1232-1239.
18. Barg A, Saltzman CL. Single-stage supramalleolar osteotomy for coronal plane deformity. Curr Rev Musculoskelet Med, 2014, 7(4): 277-291.
19. 胡永成, 邱贵兴, 马信龙, 等. 骨科疾病疗效评价标准. 北京: 人民卫生出版社, 2012: 231-267.
20. 赵宏谋, 梁晓军, 李毅, 等. 合并腓骨截骨的踝上截骨治疗内翻型踝关节炎. 中华骨科杂志, 2016, 36(16): 1025-1032.
21. 赵宏谋, 梁晓军, 李毅, 等. 胫骨远端内外翻畸形对胫距关节接触的影响. 中国修复重建外科杂志, 2016, 30(7): 826-829.

Chinese Journal of Reparative and Reconstructive Surgery

Supramalleolar osteotomy treatment of varus ankle osteoarthritis with or without fibular osteotomy

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