Distraction Arthroplasty for Ankle Osteoarthritis

Category: Ankle Arthritis Introduction/Purpose: Ankle joint distraction arthroplasty (AJDA) is an alternative surgical procedure for the management of moderate to severe ankle osteoarthritis. However, the benefit of this procedure and failure relative factors are still in debate. The purpose of current study was to evaluate the functional outcomes of AJDA in treatment of moderate to severe ankle OA; and to evaluate the relative factors correlated with treatment failure. Methods: Forty-six van Dijk stage II and III ankle osteoarthritis patients were included. Fifteen males and 31 females with a mean age of 54.8 (range, 42-71) years were followed with a mean of 42.8 (range, 24-68) months. The Ankle Osteoarthritis Scale (AOS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score were used for functional outcomes evaluation. The talar tilt (TT) angle and ankle joint space distance (AJSD) were evaluated. The risk ratio (RR) was calculated for each potential failure relative factor. Results: The AOS and AOFAS scores were significantly improved at the last followup time (P＜0.01). The AJSD was improved in 61% of patients, and with a significant improvement compared with the preoperative conditions (P＜0.01). The TT angle and range of motion reached no significant difference. The failure rate was 21.7%. Patients with large TT (>=5°) angle (RR=3.81, 95%CI: 1.28-11.33, P=0.02) and obesity (RR=3.58, 95%CI: 1.30-9.89, P=0.01) were found have positive correlation with failure. No correlation was found between failure and gender, or overweight, or side, or age, or type and stage of OA, or pin infection. Conclusion: Current study confirmed the early functional outcomes of ankle distraction arthroplasty. However, this procedure still has a relatively high failure rate, especially for those obesity patients and the patients with large TT angles.

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Ankle Distraction Arthroplasty for Ankle Osteoarthritis: A Survival Analysis

Strategies in Trauma and Limb Reconstruction ◽

10.5005/jp-journals-10080-1429 ◽

2019 ◽

Vol 14 (2) ◽

pp. 65-71

Author(s):

Austin T. Fragomen ◽

Stephen Greenfield ◽

Kelsey M Matta ◽

Thomas H McCoy ◽

S Robert Rozbruch

Keyword(s):

Survival Analysis ◽

Ankle Osteoarthritis ◽

Distraction Arthroplasty

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Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

10.21203/rs.2.17170/v2 ◽

2019 ◽

Author(s):

Koji Nozaka ◽

Naohisa Miyakoshi ◽

Takeshi Kashiwagura ◽

Yuji Kasukawa ◽

Hidetomo Saito ◽

...

Keyword(s):

Ankle Joint ◽

External Fixator ◽

Weight Bearing ◽

Tibial Osteotomy ◽

Ankle Arthritis ◽

Ankle Osteoarthritis ◽

Distraction Arthroplasty ◽

Circular External Fixator ◽

Joint Distraction ◽

Tibiotalar Arthrodesis

Abstract Background: Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. With tibiotalar arthrodesis, high levels of pain-free function are possible; however, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator on ankle osteoarthritis. Methods: A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed. Subsequently, angled osteotomy and correction of the distal tibia were performed. After ankle conditions improved, stabilization of the ankle joint was performed. An external fixator was used in all patients. In addition, joint distraction of about 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery. Results: The anteroposterior mortise angle during weight-bearing, lateral mortise angle during weight-bearing, and talar tilt angle and anterior translation of the talus on ankle stress radiography significantly improved (P < 0.05). In addition, signal changes on magnetic resonance imaging improved in all patients. Visual analogue scale and American Orthopedic Foot & Ankle Society scores also improved significantly (P < 0.05). No severe complications were observed. Conclusion: DTO with joint distraction may be useful for older patients with a high physical activity level as a joint-preserving surgery for medial ankle osteoarthritis. Level of evidence: Level IV, retrospective case series Key words : distal tibial osteotomy, medial ankle arthritis, joint distraction, circular external fixator

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Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

10.21203/rs.2.17170/v3 ◽

2020 ◽

Author(s):

Koji Nozaka ◽

Naohisa Miyakoshi ◽

Takeshi Kashiwagura ◽

Yuji Kasukawa ◽

Hidetomo Saito ◽

...

Keyword(s):

Ankle Joint ◽

External Fixator ◽

Weight Bearing ◽

Tibial Osteotomy ◽

Ankle Arthritis ◽

Ankle Osteoarthritis ◽

Distraction Arthroplasty ◽

Circular External Fixator ◽

Joint Distraction ◽

Tibiotalar Arthrodesis

Abstract Background: Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. With tibiotalar arthrodesis, high levels of pain-free function are possible; however, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator on ankle osteoarthritis. Methods: A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed. Subsequently, angled osteotomy and correction of the distal tibia were performed. After ankle conditions improved, stabilization of the ankle joint was performed. An external fixator was used in all patients. In addition, joint distraction of about 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery. Results: The anteroposterior mortise angle during weight-bearing, lateral mortise angle during weight-bearing, and talar tilt angle and anterior translation of the talus on ankle stress radiography significantly improved (P < 0.05). In addition, signal changes on magnetic resonance imaging improved in all patients. Visual analogue scale and American Orthopedic Foot & Ankle Society scores also improved significantly (P < 0.05). No severe complications were observed. Conclusion: DTO with joint distraction may be useful for older patients with a high physical activity level as a joint-preserving surgery for medial ankle osteoarthritis. Level of evidence: Level IV, retrospective case series Key words : distal tibial osteotomy, medial ankle arthritis, joint distraction, circular external fixator

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Supramalleolar Osteotomy With Distraction Arthroplasty in Treatment of Varus Ankle Osteoarthritis With Large Talar Tilt Angle: A Case Report and Literature Review

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2017.04.022 ◽

2017 ◽

Vol 56 (5) ◽

pp. 1125-1128 ◽

Cited By ~ 6

Author(s):

Hong-Mou Zhao ◽

Xiao-Jun Liang ◽

Yi Li ◽

Ning Ning ◽

Jun Lu

Keyword(s):

Case Report ◽

Literature Review ◽

Tilt Angle ◽

Ankle Osteoarthritis ◽

Distraction Arthroplasty ◽

Supramalleolar Osteotomy ◽

Talar Tilt ◽

Varus Ankle Osteoarthritis

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Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-3061-7 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 3

Author(s):

Koji Nozaka ◽

Naohisa Miyakoshi ◽

Takeshi Kashiwagura ◽

Yuji Kasukawa ◽

Hidetomo Saito ◽

...

Keyword(s):

Tibial Osteotomy ◽

Ankle Osteoarthritis ◽

Distraction Arthroplasty ◽

Varus Ankle Osteoarthritis

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Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

10.21203/rs.2.17170/v1 ◽

2019 ◽

Author(s):

Koji Nozaka ◽

Naohisa Miyakoshi ◽

Takeshi Kashiwagura ◽

Yuji Kasukawa ◽

Hidetomo Saito ◽

...

Keyword(s):

Ankle Joint ◽

External Fixator ◽

Weight Bearing ◽

Activity Level ◽

Tibial Osteotomy ◽

Ankle Osteoarthritis ◽

Distraction Arthroplasty ◽

Circular External Fixator ◽

Joint Distraction ◽

Tibiotalar Arthrodesis

Abstract Background Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. Tibiotalar arthrodesis is possible to have high levels of pain-free function, however there is loss of ankle joint movement and a risk of arthrosis of adjacent joints in the future. Distraction arthroplasty is a simple method with a possibility of the joint cartilage repair but current results are mixed with reports of patients with better pain scores and some without any improvement. Distal tibial osteotomy (DTO) without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years, However, as far as we know, there are no reports on DTO with joint distraction using a circular external fixator. The purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator on ankle osteoarthritis.Materials and Methods A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed. Then angled osteotomy and correction of the distal tibia were performed. After ankle conditions improved, the stabilization of the ankle joint was performed. An external fixator was used in all patients. In addition, joint distraction of about 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery.Results Antero-posterior mortise angle during weight-bearing, lateral mortise angle during weight-bearing, and talar tilt angle and anterior translation of the talus in ankle stress radiography significantly improved (P < 0.05). In addition, signal changes in magnetic resonance imaging (MRI) improved in all patients. Visual Analogue Scale (VAS ) and The American Orthopaedic Foot & Ankle Society (AOFAS) scores also improved significantly (P < 0.05). No severe complications were observed.Conclusion DTO with joint distraction may be useful for older patients with a high physical activity level as joint preserving surgery for medial ankle osteoarthritis.

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SMOT with Medial Distraction Arthroplasty for Ankle Arthritis with Increased Talar Tilt: A Comparative Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00256 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0025

Author(s):

Zhao Hong-Mou

Keyword(s):

Functional Evaluation ◽

Ankle Arthritis ◽

Ankle Osteoarthritis ◽

Aofas Score ◽

Hindfoot Alignment ◽

Distraction Arthroplasty ◽

Talar Tilt ◽

And Function ◽

Varus Ankle Osteoarthritis

Category: Ankle Arthritis Introduction/Purpose: An increased preoperative talar tilt (TT) angle was reported to be positively correlated with treatment failure after supramalleolar osteotomy (SMOT) for varus ankle osteoarthritis. Distraction arthroplasty was reported to have the ability to correct increased TT angles. The purpose of the current study was to compare the outcomes between SMOT with and without medial distraction arthroplasty (MDA) in the treatment of varus ankle osteoarthritis with increased TT angles. Methods: We retrospectively reviewed the functional outcomes and radiological findings of 56 patients who underwent SMOT with or without MDA for varus ankle osteoarthritis with increased TT angles. The AOFAS ankle-hindfoot score and AOS scores were used for functional evaluation. The tibial anterior surface (TAS) angle, talar tilt (TT) angle, tibial medial malleolar (TMM) angle, talocrural (TC) angle, tibial lateral surface (TLS) angle, and hindfoot alignment (HFA) angle were evaluated preoperatively and at the time of the last follow-up. Results: In the SMOT group, the AOFAS score and AOS pain and function scores were significantly improved (P <0.01 for each) at a mean follow-up of 67.5 months. The TAS, TT, TC, TLS, and HFA angles were all significantly improved (P <0.01 for each). Similarly, in the SMOT with MDA group, the AOFAS score, AOS pain and function scores, and the TAS, TT, TC, TLS, and HFA angles were all significantly improved postoperatively (P <0.01 for each) at a mean follow-up of 37.8 months. When comparing the two groups, the postoperative TT angle was significantly smaller in the SMOT with MDA group (P = 0.03) than in the SMOT group. In addition, the failure rate of TT angle correction was significantly higher in the SMOT group (P = 0.02) than in the SMOT with MDA group. Conclusion: SMOT is a promising procedure for functional improvement and malalignment correction for varus ankle osteoarthritis, even in patients with increased talar tilt. SMOT with MDA is a effective method to correct the varus ankle OA with increased talar tilt.

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