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Ankle Osteoarthritis (I): Joint Preservation Surgery

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Book cover Foot and Ankle Disorders

Abstract

  1. 1.

    The thinness of ankle articular cartilage and the small contact area, leading to high peak contact stresses, can make the joint more susceptible to posttraumatic osteoarthritis in cases of articular cartilage damage.

  2. 2.

    It appears that triamcinolone is more effective than betamethasone and methylprednisolone.

  3. 3.

    Despite the growing interest in stem cell transplantation for cartilage regeneration, knowledge on this topic is still preliminary.

  4. 4.

    Ankle arthroscopy for the treatment of ankle arthritis, excluding isolated bony impingement, is not particularly effective, and there is insufficient evidence-based literature to support the benefit of arthroscopy for the management of synovitis.

  5. 5.

    Supramalleolar osteotomy is ideally indicated for medial gutter ankle osteoarthritis (Takakura stage II or IIIA), but stage IIIB is also indicated in some select cases, where age can be an important factor.

  6. 6.

    Joint distraction with external fixation has evolved as an alternative treatment to natural joint-ablation non-preserving procedures such as ankle arthrodesis or total ankle replacement.

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References

  1. Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B. Etiology of ankle osteoarthritis. Clin Orthop Relat Res. 2009;467:1800–6.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Peyron JG. The epidemiology of osteoarthritis. In: Moskowitz RW, Howell DS, Goldberg VM, Mankin HJ, editors. Osteoarthritis: diagnosis and treatment. Philadelphia: W. B. Saunders; 1984. p. 9–27.

    Google Scholar 

  3. Demetriades L, Strauss E, Gallina J. Osteoarthritis of the ankle. Clin Orthop Relat Res. 1998;349:28–42.

    Article  PubMed  Google Scholar 

  4. Harrington KD. Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability. J Bone Faint Surg Am. 1979;61:354–61.

    CAS  Google Scholar 

  5. Saltzman CL, Salamon ML, Blanchard GM, et al. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J. 2005;25:44–6.

    PubMed Central  PubMed  Google Scholar 

  6. Schafer D, Hintermann B. Arthroscopic assessment of the chronic unstable ankle joint. Knee Surg Sports Traumatol Arthrosc. 1996;4:48–52.

    Article  CAS  PubMed  Google Scholar 

  7. Wyss C, Zollinger H. The causes of subsequent arthrodesis of the ankle joint. Acta Orthop Belg. 1991;57 Suppl 1:22–7.

    PubMed  Google Scholar 

  8. Kimizuka M, Kurosawa H, Fukubayashi T. Load-bearing pattern of the ankle joint. Contact area and pressure distribution. Arch Orthop Trauma Surg. 1980;96:45–9.

    Article  CAS  PubMed  Google Scholar 

  9. Kuettner KE, Cole AA. Cartilage degeneration in different human joints. Osteoarthritis Cartilage. 2005;13:93–103.

    Article  CAS  PubMed  Google Scholar 

  10. Kempson GE. Age-related changes in the tensile properties of human articular cartilage: a comparative study between the femoral head of the hip joint and the talus of the ankle joint. Biochim Biophys Acta. 1991;1075:223–30.

    Article  CAS  PubMed  Google Scholar 

  11. Aurich M, Squires GR, Reiner A, Mollenhauer JA, Kuettner KE, Robin Poole A, Ada A. Cole differential matrix degradation and turnover in early cartilage lesions of human knee and ankle joints. Arthritis Rheum. 2005;52(1):112–9. doi:10.1002/art.20740.

    Article  CAS  PubMed  Google Scholar 

  12. Coughlin MJ, Saltzman CL, Anderson RB. Mann’s surgery of the foot and ankle, vol. 2. 9th ed. Philadelphia: Saunders/Elsevier; 2014. p. 1041.

    Google Scholar 

  13. Mann RA, Coughlin MJ. Hallux valgus--etiology, anatomy, treatment and surgical considerations. Clin Orthop Relat Res. 1981;157:31–41.

    PubMed  Google Scholar 

  14. Coughlin MJ, Saltzman CL, Anderson RB. Mann’s surgery of the foot and Ankle, vol. 2. 9th ed. Philadelphia: Saunders/Elsevier; 2014. p. 1042.

    Google Scholar 

  15. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16:137–62.

    Article  CAS  PubMed  Google Scholar 

  16. Zhang W, Nuki G, Moskowitz R, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis, Part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage. 2010;18:476–99.

    Article  CAS  PubMed  Google Scholar 

  17. National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults. London: Royal College of Physicians; 2008.

    Google Scholar 

  18. American Academy of Orthopaedic Surgeons (AAOS). American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis of the knee (non-arthroplasty). American academy of orthopaedic surgeons. Rosemont; 2008.

    Google Scholar 

  19. Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther K-P, Hauselmann HJ, Herrero-Beaumont G, Jordan K, Kaklamanis P, Leeb B, Lequesne M, Lohmander S, Mazieres B, Martin-Mola E, Pavelka K, Pendleton A, Punzi L, Swoboda B, Varatojo R, Verbruggen G, Zimmermann-Gorska I, Dougados M. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2005;64:669–81.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Bjordal JM, Klovning A, Ljunggren AE, Slørdal L. Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: a meta-analysis of randomised placebo-controlled trials. Eur J Pain. 2007;11:125–38.

    Article  CAS  PubMed  Google Scholar 

  21. Bjordal JM, Ljunggren AE, Klovning A, Slørdal L. Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials. BMJ. 2004;329:1317.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Nüesch E, Rutjes AW, Husni E, Welch V, Jüni P. Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database Syst Rev. 2009;(4):CD003115. doi:10.1002/14651858.CD003115.pub3.

  23. Ofman JJ, MacLean CH, Straus WL, Morton SC, Berger ML, Roth EA, et al. A metaanalysis of severe upper gastrointestinal complications of nonsteroidal antiinflammatory drugs. J Rheumatol. 2002;29:804–12.

    CAS  PubMed  Google Scholar 

  24. Witteveen AG, Giannini S, Guido G, Jerosch J, Lohrer H, Vannini F, Donati L, Schulz A, Scholl J, Sierevelt IN, van Dijk CN. A prospective multi-centre, open study of the safety and efficacy of hylan G-F 20 (Synvisc) in patients with symptomatic ankle (talo-crural) osteoarthritis. Foot Ankle Surg. 2008;14(3):145–52. doi:10.1016/j.fas.2008.01.001. Epub 2008 Mar 4.

    Article  PubMed  Google Scholar 

  25. Witteveen AG, Sierevelt IN, Blankevoort L, Kerkhoffs GM, van Dijk CN. Intraarticular sodium hyaluronate injections in the osteoarthritic ankle joint: effects, safety and dose dependency. Foot Ankle Surg. 2010;16:159–63.

    Article  PubMed  Google Scholar 

  26. DeGroot III H, Uzunishvili S, Weir R, Al-omari A, Gomes B. Intra-articular injection of hyaluronic acid is not superior to saline solution injection for ankle arthritis: a randomized, double-blind, placebo-controlled study. J Bone Joint Surg Am. 2012;94:2–8.

    Article  PubMed  Google Scholar 

  27. Chang KV, Hsiao MY, Chen WS, Wang TG, Chien KL. Effectiveness of intra-articular hyaluronic acid for ankle osteoarthritis treatment: a systematic review and ㅡmeta-analysis. Arch Phys Med Rehabil. 2013;94(5):951–60.

    Article  PubMed  Google Scholar 

  28. Lucas Y, Hermandez J, Darcel V, Chauveaux D, Laffenetre O. Viscosupplementation of the ankle: a prospective study with an average follow-up of 45.5 months. Orthop Traumatol Surg Res. 2013;99(5):593–9.

    Article  Google Scholar 

  29. Bashaireh K, Naser Z, Hawadya KA, Al-Khateep RN. Efficacy and safety of cross-linked hyaluronic acid single injection on osteoarthritis of the knee: a post-marketing Phase IV study. Drug Des Devel Ther. 2015;9:2063–72.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Cheng OT, Souzdalnitski D, Vrooman B, Cheng J. Evidence-based knee injections for the management of arthritis. Pain Med. 2012;13:740–53.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Godwin M, Dawes M. Intra-articular steroid injections for painful knees. Systematic review with metaanalysis. Can Fam Physician. 2004;50:241–8. Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ. 2004;328:869–70.

    PubMed Central  PubMed  Google Scholar 

  32. Hepper CT, Halverson JJ, Duncan ST, et al. The efficacy and duration of intraarticular corticosteroid injection for knee osteoarthritis: a systematic review of level I studies. J Am Acad Orthop Surg. 2009;17:638–46.

    PubMed  Google Scholar 

  33. Cheng J, Abdi S. Complications of joint, tendon and muscle injections. Tech Reg Anesth Pain Manag. 2007;11:141–7.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Habib GS, Saliba W, Nashashibi M. Local effects of intra-articular corticosteroids. Clin Rheumatol. 2010;29:347–56.

    Article  PubMed  Google Scholar 

  35. Hunter JA, Blyth TH. A risk-benefit assessment of intraarticular corticosteroids in rheumatic disorders. Drug Saf. 1999;21:353–65.

    Article  CAS  PubMed  Google Scholar 

  36. Uziel Y, Berkovitch M, Gazarian M, et al. Evaluation of eutectic lidocaine/prilocaine cream (EMLA) for steroid joint injection in children with juvenile rheumatoid arthritis: a double blind, randomized, placebo controlled trial. J Rheumatol. 2003;30:594–6.

    CAS  PubMed  Google Scholar 

  37. Mei-Dan O, Carmont MR, Laver L, Mann G, Maffulli N, Nyska M. Platelet-rich plasma or hyaluronate in the management of osteochondral lesions of the talus. Am J Sports Med. 2012;40(3):534–41. doi:10.1177/0363546511431238. Epub 2012 Jan 17.

    Article  PubMed  Google Scholar 

  38. Richter M, Zech S. Matrix-associated stem cell transplantation (MAST) in chondral defects of foot and ankle is effective. Foot Ankle Surg. 2013;19(2):84–90. doi:10.1016/j.fas.2012.11.005. Epub 2012 Dec 21.

    Article  PubMed  Google Scholar 

  39. Filardo G, Madry H, Jelic M, Roffi A, Cucchiarini M, Kon E. Mesenchymal stem cells for the treatment of cartilage lesions: from preclinical findings to clinical application in orthopaedics. Knee Surg Sports Traumatol Arthrosc. 2013;21(8):1717–29. doi:10.1007/s00167-012-2329-3. Epub 2013 Jan 11.

    Article  PubMed  Google Scholar 

  40. Glazebrook MA, Ganapathy V, Bridge MA, Stone JW, Allard JP. Evidence-based indications for ankle arthroscopy. Arthroscopy. 2009;25(12):1478–90.

    Article  PubMed  Google Scholar 

  41. Oneda Y, Sugimoto K, Takakura Y. Three dimensional contact stress analysis of the ankle joint. J Jpn Soc Surg Foot. 1989;11:91–3.

    Google Scholar 

  42. Becker AS, Myerson MS. The indications and technique of supramalleolar osteotomy. Foot Ankle Clin. 2009;14(3):549–61.

    Article  PubMed  Google Scholar 

  43. Stamatis ED, Cooper PS, Myerson MS. Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint. Foot Ankle Int. 2003;24(10):754–64.

    PubMed  Google Scholar 

  44. Tanaka Y, Takakura Y, Hayashi K, Taniguchi A, Kumai T, Sugimoto K. Low tibial osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg Br. 2006;88:909–13.

    Article  CAS  PubMed  Google Scholar 

  45. Kim YS, Park EH, Koh YG, Lee JW. Supramalleolar osteotomy with bone marrow stimulation for varus ankle osteoarthritis: clinical results and second-look arthroscopic evaluation. Am J Sports Med. 2014;42(7):1558–66. doi:10.1177/0363546514530669.

    Article  PubMed  Google Scholar 

  46. Barg A, Pagenstert G, Leumann A, Valderrabano V. Malleolar osteotomy—osteotomy as approach. Orthopade. 2013;42(5):309–21.

    Article  CAS  PubMed  Google Scholar 

  47. Knupp M, Pagenstert G, Valderrabano V, Hintermann B. Osteotomies in varus malalignment of the ankle. Oper Orthop Traumatol. 2008;20(3):262–73.

    Article  PubMed  Google Scholar 

  48. Knupp M, Stufkens SA, Pagenstert G, Hintermann B, Valderrabano V. Supramalleolar osteotomy for tibiotalar varus malalignment. Tech Foot Ankle. 2009;8:17–23.

    Article  Google Scholar 

  49. Sugimoto K, Samoto N, Takakura Y, Tamai S. Varus tilt of the tibial plafond as a factor in chronic ligament instability of the ankle. Foot Ankle Int. 1997;18(7):402–5.

    Article  CAS  PubMed  Google Scholar 

  50. Takakura Y, Tanaka Y, Kumai T, Tamai S. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg Br. 1995;77(1):50–4.

    CAS  PubMed  Google Scholar 

  51. Harstall R, Lehmann O, Krause F, Weber M. Supramalleolar lateral closing wedge osteotomy for the treatment of varus ankle arthrosis. Foot Ankle Int. 2007;28(5):542–8.

    Article  PubMed  Google Scholar 

  52. Barg A, Pagenstrt GI, Horisberger M, Paul J, Gloyer M, Henninger HB, Valderrano V. Supramalleolar osteotomies for degenerative joint disease of the ankle joint: indication, technique and results. Int Orthop. 2013;37(9):1683–95.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Lee WC, Moon JS, Lee K, Byun WJ, Lee SH. Indications for supramalleolar osteotomy in patients with ankle osteoarthritis and varus deformity. J Bone Joint Surg Am. 2011;93(13):1243–8.

    Article  PubMed  Google Scholar 

  54. Cheng YM, Huang PJ, Hong SH, Lin SY, Liao CC, Chiang HC, et al. Low tibial osteotomy for moderate ankle arthritis. Arch Orthop Trauma Surg. 2001;121(6):355–8.

    Article  CAS  PubMed  Google Scholar 

  55. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Clin Orthop North Am. 1979;10:585–608.

    CAS  Google Scholar 

  56. Jung WH, Takeuchi R, Chun CW, Lee JS, Ha JH, Kim JH, Jeong JH. Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Arthroscopy. 2014;30(1):72–9.

    Article  PubMed  Google Scholar 

  57. Koshino T, Tsuchiya K. The effect of high tibial osteotomy on osteoarthritis of the knee. Clinical and histological observation. Int Orthop. 1979;3:37–45.

    Article  CAS  PubMed  Google Scholar 

  58. Koshino T, Wada S, Ara Y, Saito T. Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee. 2003;10(3):229–36.

    Article  PubMed  Google Scholar 

  59. Benthien RA, Myerson MS. Supramalleolar osteotomy for ankle deformity and arthritis. Foot Ankle Clin. 2004;9(3):475–87.

    Article  PubMed  Google Scholar 

  60. Hintermann B, Knupp M, Barg A. Osteotomies of the distal tibia and hindfoot for ankle realignment. Orthopade. 2008;37(3):212–3.

    Article  CAS  PubMed  Google Scholar 

  61. Knupp M, Stufkens SA, Bolliger L, Barg A, Hintermann B. Classification and treatment of supramalleolar deformities. Foot Ankle Int. 2011;32:1023–31.

    Article  PubMed  Google Scholar 

  62. Pagenstert GI, Hintermann B, Barg A, Leumann A, Valderrabano V. Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res. 2007;462:156–68.

    Article  PubMed  Google Scholar 

  63. Takakura Y, Takaoka T, Tanaka Y, Yajima H, Tamai S. Results of opening-wedge osteotomy for the treatment of a post-traumatic varus deformity of the ankle. J Bone Joint Surg Am. 1998;80(2):213–8.

    CAS  PubMed  Google Scholar 

  64. Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43-B(4):752–7.

    CAS  PubMed  Google Scholar 

  65. van Valburg AA, van Roermund PM, Marijnissen ACA, et al. Joint distraction in treatment of osteoarthritis: a two-year follow-up of the ankle. Osteoarthritis Cartilage. 1999;7:474–9.

    Article  PubMed  Google Scholar 

  66. van Valburg AA, van Roermund PM, Lammens L, et al. Can Ilizarov joint distraction delay the need for an arthrodesis of the ankle? A preliminary report. J Bone Joint Surg Br. 1995;77:720–5.

    PubMed  Google Scholar 

  67. Sabharwal S, Schwechter EM. Five-year followup of ankle joint distraction for post-traumatic chondrolysis in an adolescent: a case report. Foot Ankle Int. 2007;28:942–8.

    Article  PubMed  Google Scholar 

  68. Intema F, Thomas TP, Anderson DD, et al. Subchondral bone remodeling is related to clinical improvement after joint distraction in the treatment of ankle osteoarthritis. Osteoarthritis Cartilage. 2011;19:668–75.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  69. Marijnissen AC, Vincken KL, Viergever MA, et al. Ankle images digital analysis (AIDA): digital measurement of joint space width and subchondral sclerosis on standard radiographs. Osteoarthritis Cartilage. 2001;9(3):264–72.

    Article  CAS  PubMed  Google Scholar 

  70. Saltzman CL, Hillis SL, Stolley MP, et al. Motion versus fixed distraction of the joint in the treatment of ankle osteoarthritis: a prospective randomized controlled trial. J Bone Joint Surg Am. 2012;94(11):961–70.

    Article  PubMed Central  PubMed  Google Scholar 

  71. Van Roermund PM, Lafeber FP. Joint distraction as treatment for ankle osteoarthritis. Instr Course Lect. 1999;48:249–54.

    PubMed  Google Scholar 

  72. Paley D, Lamm BM, Purohit RM, et al. Distraction arthroplasty of the ankle–how far can you stretch the indications? Foot Ankle Clin. 2008;13(3):471–84. ix.

    Article  PubMed  Google Scholar 

  73. Coughlin MJ, Saltzman CL, Anderson RB. Mann’s surgery of the foot and ankle, vol. 2. 9th ed. Philadelphia: Saunders/Elsevier; 2014. p. 1176.

    Google Scholar 

  74. Ploegmakers J, van Roermund PM, van Melkebeek L, et al. Prolonged clinical benefit from joint distraction in the treatment of ankle osteoarthritis. Osteoarthritis Cartilage. 2005;13:582–8.

    Article  CAS  PubMed  Google Scholar 

  75. Tellisi N, Fragomen AT, Kleinman O, et al. Joint preservation of the osteoarthritic ankle using distraction arthroplasty. Foot Ankle Inc. 2009;30:318–25.

    Article  Google Scholar 

  76. Coughlin MJ, Saltzman CL, Anderson RB. Mann’s surgery of the foot and ankle, vol. 2. 9th ed. Philadelphia: Saunders/Elsevier; 2014. p. 1178.

    Google Scholar 

  77. Barg A, Amendola A, Beaman DN, Saltzman CL. Ankle joint distraction arthroplasty: why and how? Foot Ankle Clin North Am. 2013;18:459–70.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea

    Joon Sang Eom

  2. Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea

    Hong-Geun Jung MD, PhD

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Correspondence to Hong-Geun Jung MD, PhD .

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  1. Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea (Republic of)

    Hong-Geun JUNG

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Eom, J.S., Jung, HG. (2016). Ankle Osteoarthritis (I): Joint Preservation Surgery. In: JUNG, HG. (eds) Foot and Ankle Disorders. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54493-4_6

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