Abstract
Objective To evaluate the functional and radiological outcomes of supramalleolar osteotomy (SMOT) with fibular osteotomy for mid-staged varus ankle arthritis. Methods From April 2009 to April 2014, data of twenty-two patients with mid-staged varus ankle osteoarthritis who were treated with SMOT combined with fibular osteotomy and were followed up at least one yearwere retrospectively analyzed. There were 5 males and 17 females with mean age of 52.4 years (range, 37-71 years). According to modified Takakura ankle osteoarthritis stage, there were 5 cases in stage II, 12 in stage IIIa and 5 stage in IIIb. The American orthopedic foot and ankle society (AOFAS) ankle-hind score, Maryland foot score and Ankle Osteoarthritis Scale (AOS) were used for pre-and postoperative functional evaluation, as well as the range of motion (ROM) of ankle joint on sagittal plane. The tibial anterior surface angle (TAS), talar tilt (TT), tibiocrural angle (TC), and tibial lateral surface angle (TLS) were evaluated pre-and postoperatively. Results The mean follow-up time was 36.6 (range, 17-55) months. Two cases had delay union. One case with postoperative pain and dysfunction was treated by ankle fusion. All of the osteotomy sites reached bony union with a mean time of 3.9 months (range, 3-8 months). The mean AOFAS score and Maryland score and AOS pain and function scores were improved significantly; the mean AOFAS score increased 31.7±12.5 points, the mean Maryland score increased 22.1±11.5 points, and the mean AOS pain and functional score reduced 16.1±7.4 and 15.6±6.9 respectively. Thirteen cases (62%) had improved on modified Takakura stages, 6 from stage II/III to stage I, 6 from stage III to stage II, and 1 from stage IIIb to stage IIIa. The ROM on sagittal plane increased from 32.8°±5.3° preoperatively to 35.7°±5.9° postoperatively.. For radiological evaluation, all the parameters were improved except TLS; the TAS reached a mean improvement of 7.2°±2.8°, the TT with a mean improvement of 4.4°±3.6°, the TC with a mean improvement of 9.8°±3.5°, the TLS with a mean improvement of 0.7°±1.2°. Conclusion SMOT combined with fibular osteotomy is promising with substantial functional improvement and malalignment correction for varus ankle arthritis; and is helpful even for those cases with large talar tilt angle. However, this procedure has no obvious improvement effect on the ROM of sagittal plane of ankle joint. Key words: Ankle joint; Osteoarthritis; Fibula; Osteotomy
Published Version
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