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Supramalleolar osteotomy in post-traumatic valgus ankle osteoarthritis

  • Nicola KrähenbühlEmail author
  • Roman Susdorf
  • Alexej Barg
  • Beat Hintermann
Original Paper
  • 38 Downloads

Abstract

Purpose

To assess how the level of the deformity, the stage of the osteoarthritic process, and the role of additional surgeries impact radiographic and clinical outcomes following an extra-articular medial closing supramalleolar osteotomy for treatment of post-traumatic valgus ankle osteoarthritis.

Methods

About 56 consecutive patients who underwent an extra-articular medial closing wedge osteotomy for post-traumatic valgus ankle osteoarthritis were retrospectively analyzed. Subgroups were formed according to the pre-operative level of deformity and preoperative stage of ankle osteoarthritis. Additional surgical steps required to achieve a properly balanced hindfoot were also noted. Radiographic and clinical outcomes of each subgroup were compared with each other, and the role of additional surgical steps required to achieve a balanced hindfoot was investigated.

Results

Radiographic and clinical outcomes improved significantly between pre-operative assessment and the last follow-up. Patients with a pre-operative supramalleolar deformity showed superior radiographic outcomes compared to patients with an intra-articular deformity. Clinical outcomes did not differ significantly between these two subgroups. The pre-operative stage of ankle osteoarthritis significantly impacted radiographic outcomes but did not influence clinical outcome measures. An additional fibula or calcaneus osteotomy was necessary for 55% and 23% of all patients, respectively.

Conclusion

Extra-articular medial closing supramalleolar osteotomies show satisfactory mid- to long-term radiographic and clinical outcomes in patients with post-traumatic valgus ankle osteoarthritis.

Keywords

Ankle osteoarthritis Valgus deformity Supramalleolar osteotomy Realignment surgery 

Notes

Acknowledgments

The authors thank Maxwell Weinberg, a study coordinator at the University of Utah Orthopedic Center, who provided editorial support.

Funding information

This work was supported by a grant from the University of Basel (Excellent Junior Research Grant).

Compliance with ethical standards

Conflict of interests

Alexej Barg has received personal fees from Medartis (not related to the article) during the conduct of the study. Nicola Krähenbühl, Roman Susdorf, and Beat Hintermann declare that they have no conflict of interests.

Supplementary material

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References

  1. 1.
    Knupp M, Stufkens SA, Bolliger L, Barg A, Hintermann B (2011) Classification and treatment of supramalleolar deformities. Foot Ankle Int 32(11):1023–1031CrossRefGoogle Scholar
  2. 2.
    Lee WC, Moon JS, Lee K, Byun WJ, Lee SH (2011) Indications for supramalleolar osteotomy in patients with ankle osteoarthritis and varus deformity. J Bone Joint Surg Am 93(13):1243–1248.  https://doi.org/10.2106/JBJS.J.00249 CrossRefPubMedGoogle Scholar
  3. 3.
    Ahn TK, Yi Y, Cho JH, Lee WC (2015) A cohort study of patients undergoing distal tibial osteotomy without fibular osteotomy for medial ankle arthritis with mortise widening. J Bone Joint Surg Am 97(5):381–388.  https://doi.org/10.2106/JBJS.M.01360 CrossRefPubMedGoogle Scholar
  4. 4.
    Hongmou Z, Xiaojun L, Yi L, Hongliang L, Junhu W, Cheng L (2016) Supramalleolar osteotomy with or without fibular osteotomy for varus ankle arthritis. Foot Ankle Int 37(9):1001–1007.  https://doi.org/10.1177/1071100716649926 CrossRefPubMedGoogle Scholar
  5. 5.
    Hintermann B, Ruiz R, Barg A (2017) Novel double osteotomy technique of distal tibia for correction of asymmetric varus osteoarthritic ankle. Foot Ankle Int 38(9):970–981.  https://doi.org/10.1177/1071100717712543 CrossRefPubMedGoogle Scholar
  6. 6.
    Krahenbuhl N, Zwicky L, Bolliger L, Schadelin S, Hintermann B, Knupp M (2017) Mid- to long-term results of Supramalleolar osteotomy. Foot Ankle Int 38(2):124–132.  https://doi.org/10.1177/1071100716673416 CrossRefPubMedGoogle Scholar
  7. 7.
    Haraguchi N, Ota K, Tsunoda N, Seike K, Kanetake Y, Tsutaya A (2015) Weight-bearing-line analysis in supramalleolar osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg Am 97(4):333–339.  https://doi.org/10.2106/JBJS.M.01327 CrossRefPubMedGoogle Scholar
  8. 8.
    Krahenbuhl N, Akkaya M, Deforth M, Zwicky L, Barg A, Hintermann B (2019) Extraarticular supramalleolar osteotomy in asymmetric varus ankle osteoarthritis. Foot Ankle Int.  https://doi.org/10.1177/1071100719845928 CrossRefGoogle Scholar
  9. 9.
    Sokolowski M, Krahenbuhl N, Wang C, Zwicky L, Schweizer C, Horn Lang T, Hintermann B (2019) Secondary Subtalar joint osteoarthritis following total ankle replacement. Foot Ankle Int.  https://doi.org/10.1177/1071100719859216 CrossRefGoogle Scholar
  10. 10.
    Daniels TR, Younger AS, Penner M, Wing K, Dryden PJ, Wong H, Glazebrook M (2014) Intermediate-term results of total ankle replacement and ankle arthrodesis: a COFAS multicenter study. J Bone Joint Surg Am 96(2):135–142.  https://doi.org/10.2106/JBJS.L.01597 CrossRefPubMedGoogle Scholar
  11. 11.
    Sheridan BD, Robinson DE, Hubble MJ, Winson IG (2006) Ankle arthrodesis and its relationship to ipsilateral arthritis of the hind- and mid-foot. J Bone Joint Surg (Br) 88(2):206–207.  https://doi.org/10.1302/0301-620X.88B2.17065 CrossRefGoogle Scholar
  12. 12.
    Krahenbuhl N, Siegler L, Deforth M, Zwicky L, Hintermann B, Knupp M (2019) Subtalar joint alignment in ankle osteoarthritis. Foot Ankle Surg 25(2):143–149.  https://doi.org/10.1016/j.fas.2017.10.004 CrossRefPubMedGoogle Scholar
  13. 13.
    Magerkurth O, Knupp M, Ledermann H, Hintermann B (2006) Evaluation of hindfoot dimensions: a radiological study. Foot Ankle Int 27(8):612–616CrossRefGoogle Scholar
  14. 14.
    Nosewicz TL, Knupp M, Bolliger L, Hintermann B (2012) The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles. Skelet Radiol 41(12):1567–1573.  https://doi.org/10.1007/s00256-012-1421-6 CrossRefGoogle Scholar
  15. 15.
    Stufkens SA, Barg A, Bolliger L, Stucinskas J, Knupp M, Hintermann B (2011) Measurement of the medial distal tibial angle. Foot Ankle Int 32(3):288–293.  https://doi.org/10.3113/FAI.2011.0288 CrossRefPubMedGoogle Scholar
  16. 16.
    Yi Y, Cho JH, Kim JB, Kim JY, Park SY, Lee WC (2017) Change in talar translation in the coronal plane after mobile-bearing total ankle replacement and its association with lower-limb and Hindfoot alignment. J Bone Joint Surg Am 99(4):e13.  https://doi.org/10.2106/JBJS.15.01340 CrossRefPubMedGoogle Scholar
  17. 17.
    Akoh CC, Phisitkul P (2019) Clinical examination and radiographic assessment of the cavus foot. Foot Ankle Clin 24(2):183–193.  https://doi.org/10.1016/j.fcl.2019.02.002 CrossRefPubMedGoogle Scholar
  18. 18.
    Huskisson EC (1974) Measurement of pain. Lancet 2(7889):1127–1131CrossRefGoogle Scholar
  19. 19.
    Hintermann B, Knupp M, Barg A (2016) Supramalleolar osteotomies for the treatment of ankle arthritis. J Am Acad Orthop Surg 24(7):424–432.  https://doi.org/10.5435/JAAOS-D-12-00124 CrossRefPubMedGoogle Scholar
  20. 20.
    Hintermann B, Zwicky L, Schweizer C, Ruiz R, Barg A (2017) The use of supramalleolar osteotomies in posttraumatic deformity and arthritis of the ankle. JBJS Essent Surg Tech 7(4):e29.  https://doi.org/10.2106/JBJS.ST.16.00081 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Knupp M (2017) The use of osteotomies in the treatment of asymmetric ankle joint arthritis. Foot Ankle Int 38(2):220–229.  https://doi.org/10.1177/1071100716679190 CrossRefPubMedGoogle Scholar
  22. 22.
    Douglas Bates MM, Bolker B, Walker S (2015) Fitting Linear Mixed-Effects Models Using lme4. J Stat Softw 67(1):1–48.  https://doi.org/10.18637/jss.v067.i01 CrossRefGoogle Scholar
  23. 23.
    R Core Team (2015) R: A language and environment for statistical computing. R Foundation for Statistical Computing 2015; Vienna, Austria. (http://www.R-project.org/)
  24. 24.
    Hintermann B, Barg A, Knupp M (2011) Corrective supramalleolar osteotomy for malunited pronation-external rotation fractures of the ankle. J Bone Joint Surg (Br) 93(10):1367–1372.  https://doi.org/10.1302/0301-620X.93B10.2694 CrossRefGoogle Scholar
  25. 25.
    Weber BG, Simpson LA (1985) Corrective lengthening osteotomy of the fibula. Clin Orthop Relat Res 199:61–67Google Scholar

Copyright information

© SICOT aisbl 2020

Authors and Affiliations

  1. 1.Department of OrthopaedicsKantonsspital BasellandLiestalSwitzerland
  2. 2.Department of OrthopaedicsUniversity of UtahSalt Lake CityUSA

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