Abstract
BackgroundIn 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.MethodsA 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.ResultsThe 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.ConclusionDTO 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 evidenceLevel IV, retrospective case series.
Highlights
In highly active older individuals, end-stage ankle osteoarthritis has traditionally been treated using tibiotalar arthrodesis, which provides considerable pain relief
To date, ankle arthrodesis or total ankle arthroplasty has been performed in patients with progressive or endstage ankle osteoarthritis
In patients with progressive or end-stage ankle osteoarthritis, total ankle arthroplasty is indicated for cases with bilateral involvement or degeneration in the adjacent joints
Summary
In highly active older individuals, end-stage ankle osteoarthritis has traditionally been treated using tibiotalar arthrodesis, which provides considerable pain relief. To our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. The purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator for treating ankle osteoarthritis. Tellisi and Fragomen [15] reported that in terms of joint preservation in the osteoarthritic ankle, older patients (more than 60 years old) tend to have better outcomes with distraction arthroplasty than their younger counterparts. Horn and Fragomen [16] reported that supramalleolar osteotomy using circular external fixation is an effective method for correcting distal tibial deformities in the adult population. Plafond-plasty is well indicated for various stages of intra-articular varus ankle osteoarthritis (including stage IIIB) associated with ankle instability [17]
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