Mid-Term Follow-Up of the Result of Periarticular Osteotomy in Treating Asymmetrical Ankle Arthritis

Abstract

Category: Ankle Arthritis Introduction/Purpose: A retrospective control study to evaluate periarticular osteotomy in treating asymmetrical ankle arthritis. Methods: Fifty-two consecutive patients with asymmetrical ankle arthritis were collected between 2009 and 2012. Forty-two of them were followed up. All the cases were performed the surgery of periarticular osteotomy including supramalleolar tibial osteotomy in 14 cases, supramalleolar tibial and fibular osteotomy in 5 cases, supramalleolar osteotomy combined with calcaneal osteotomy in 23 cases. Thirty cases got ligament reconstruction procedures. The age of surgery ranged from 31 to 70 years old (mean, 55.5). According to the Takakura classification of ankle arthritis, there were 16 cases in grade Ⅲa, and 26 cases in grade Ⅲb. The AOFAS-HA score and radiographic examinations including TAS and TLS were recorded and compared before and after surgery. Magnetic resonance imaging of the ankles were obtained before and after surgery (midterm result) in fifteen patients to evaluated the condition of the cartilage. Results: The average follow-up time was 44.5 months (36 to 75 months). All the patients got complete bone healing with an average healing time of 8 weeks. Average postoperative AOFAS -HA score by the last followup was 76.6±4.4 (compare with 35.7±5.6 preoperatively). Delayed wound healing occurred in 5 cases and was solved by wound care. All the cases had improvements in Takakura ankle arthritis classification by the last follow-up after surgery. Twenty-two patients felt the result of excellent, 20 felt good. The radiological assessment by the last followup showed no worsening of the ankle arthritis grade. None of these patients received or want to receive further surgeries such as ankle arthrodesis or ankle replacement. Conclusion: Periarticular osteotomy is a sound method in treating asymmetrical arthritis of the ankle in the midterm followup. This procedure can alter or decrease the contact pressures on the degenerated cartilage with mechanical realignment and can prolong the life span of the ankle itself.