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

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To compare the functional and radiological outcomes of supramalleolar osteotomy (SMOT) between with and without fibular osteotomy for varus ankle osteoarthritis. 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. 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). SMOT with fibular osteotomy is helpful in correction of TT and TC in patients with relative longer fibula.