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, 21 (1), 31

Effectiveness of Distal Tibial Osteotomy With Distraction Arthroplasty in Varus Ankle Osteoarthritis

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Effectiveness of Distal Tibial Osteotomy With Distraction Arthroplasty in Varus Ankle Osteoarthritis

Koji Nozaka et al. BMC Musculoskelet Disord.

Abstract

Background: In highly active older individuals, end-stage ankle osteoarthritis has traditionally been treated using tibiotalar arthrodesis, which provides considerable pain relief. However, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy is a type of joint preservation surgery that has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator for treating ankle osteoarthritis.

Methods: A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed, followed by angled osteotomy and correction of the distal tibia; the ankle joint was then stabilized after its condition improved. An external fixator was used in all patients, and joint distraction of approximately 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery.

Results: The anteroposterior and lateral mortise angle during weight-bearing, talar tilt angle, and anterior translation of the talus on ankle stress radiography were improved significantly (P < 0.05). Signal changes on magnetic resonance imaging also improved in all patients. Visual analog scale and American Orthopedic Foot & Ankle Society scores improved significantly (P < 0.05), and no severe complications were observed.

Conclusion: DTO with joint distraction may be useful as a joint-preserving surgery for medial ankle osteoarthritis in older patients with high levels of physical activity.

Level of evidence: Level IV, retrospective case series.

Keywords: Circular external fixator; Distal tibial osteotomy; Joint distraction; Medial ankle arthritis.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Osteotomy fluoroscopic images. a Varus tilt of the talus on anteroposterior fluoroscopic imaging before osteotomy. b Lateral fluoroscopic image before osteotomy. c Fluoroscopic image after osteotomy. The deformity has been corrected in the coronal plane. d Fluoroscopic image taken after osteotomy. Correction is performed until the radiographic signs of subluxation disappear on lateral fluoroscopy imaging
Fig. 2
Fig. 2
The distal bone fragment is fixed in place just above the ankle with six straight wires
Fig. 3
Fig. 3
A foot ring was used for joint distraction. a Before joint distraction. b After joint distraction (arrows)
Fig. 4
Fig. 4
Full weight-bearing walking immediately after surgery
Fig. 5
Fig. 5
Patients treated with joint distraction perform articulation while wearing an external fixator, allowing for an increased range of motion (ROM). a Dorsiflexion. b Plantarflexion
Fig. 6
Fig. 6
Pre- and postoperative images. a Preoperative antero-posterior mortise angle on X-ray. b Postoperative antero-posterior mortise angle on X-ray. c Preoperative lateral mortise angle on X-ray. d Postoperative lateral mortise angle on X-ray. e Preoperative talar tilt angle on ankle stress radiography. f Postoperative talar tilt angle on ankle stress radiography. g Postoperative anterior translation of the talus on ankle stress radiography. h Postoperative anterior translation of the talus on ankle stress radiography. i Signal changes (arrow) observed on magnetic resonance imaging (MRI) before osteotomy. j Signal changes (arrow) on MRI disappeared after osteotomy
Fig. 7
Fig. 7
79-year-old female with ankle osteoarthritis (stage IIIB). a and b Before surgery. c and d After surgery. Narrowing of the joint space has been reduced

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