Deformity Correction and Distraction Arthroplasty for Ankle Arthritis

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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Ankle joint distraction arthroplasty for severe ankle arthritis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-017-1457-9 ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 8

Author(s):

Yang Xu ◽

Yuan Zhu ◽

Xiang-yang Xu

Keyword(s):

Ankle Joint ◽

Ankle Arthritis ◽

Distraction Arthroplasty ◽

Joint Distraction

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Should the Tibiotalar Angle Be Measured Using an AP or Mortise X-ray?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00364 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0036

Author(s):

Ali-Asgar Najefi ◽

Olatunbosun Buraimoh ◽

Andrew Goldberg

Keyword(s):

Articular Surface ◽

Deformity Correction ◽

Normal Group ◽

Ankle Arthritis ◽

First Line ◽

Lateral Border ◽

The United Kingdom ◽

Significant Difference ◽

The Mean ◽

Radiographic Changes

Category: Basic Sciences/Biologics Introduction/Purpose: The tibiotalar angle(TTA) is an important radiographic tool to determine alignment or malalignment of the ankle and hindfoot.Two methods of measuring the TTA have been described. The midline TTA(MTTA) is when the first line is along the anatomical axis of the tibia, and the second line is along the superior articular surface of the talus. Another method measures a line along the lateral border of the tibia, and a line along the superior articular surface of the talus (the lateral TTA, LTTA). The aims of the study were to compare the two angles as measured on mortise and AP radiographs in normal and pathological cases.We also compared the MTTA and LTTA, to see if they are comparable and if both methods are reliable and reproducible. Methods: A retrospective radiograph review was performed of sequential ankle radiographs taken between 2016 and 2017 across 4 specialist orthopaedic centres in the United Kingdom. Patients were categorised into two distinct groups. In the Normal Group (NG), patients had no evidence of injury and normal radiological appearances. In the Arthritis Group (AG), patients had radiographic changes as per the Kellgren-Lawrence scale 2 to 4. All radiographs were weightbearing and classified as either AP or mortise views based on the position of the talus and overlap of the tibia and fibula. The MTTA and the LTTA were measured on each radiograph. Results: There were 320 radiographs for review;158 normal radiographs and 162 radiographs had arthritis.There were 117 AP and 203 mortise radiographs. The overall mean MTTA was 88.7±5.1 degrees(range 77-104), and the mean LTTA was 87.5±5.2 degrees(range 73-104);p<0.01.There was no significant difference between the MTTA and LTTA in the normal group. There was a significant difference(p<0.01) when comparing the MTTA and LTTA in the arthritis group(Table 1). There was no significant difference when the MTTA was measured between the AP and Mortise radiographs. There was a significant difference in the LTTA between AP and mortise radiographs(p=0.04). There was no significant difference between the MTTA or LTTA when measuring the angles on AP radiographs(p=0.09).However, there was a significant difference when measuring these angles in the mortise radiographs(p=0.02). Conclusion: Understanding the tibiotalar angle is key to planning for deformity correction. It is important that consistency of methods for measurement are used for reporting. In this paper we have shown the MTTA to be a reliable and reproducible tool for measuring the TTA, in both normal ankle radiographs and in patients with ankle arthritis. There is no significant difference when the MTTA is measured using an AP or a mortise radiograph. In contrast, we have shown that the LTTA to be unreliable and statistically different when measured on both AP and mortise radiographs.

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Clinical Outcomes of Ankle Distraction Arthroplasty Versus Supramalleolar Osteotomy

10.21203/rs.3.rs-739137/v1 ◽

2021 ◽

Author(s):

Zongyu Yang ◽

Liang Cui ◽

Shiwu Tao ◽

Li Wang ◽

Fengqi Zhang ◽

...

Keyword(s):

Young Patients ◽

Ankle Arthritis ◽

Level Of Evidence ◽

Distraction Arthroplasty ◽

Supramalleolar Osteotomy ◽

Significant Difference ◽

Post Traumatic ◽

Improved Function ◽

Surface Angle

Abstract BackgroundPost-traumatic ankle arthritis is increasing in young people and it is very important to preserve the ankle range of motion in young patients. This study aimed to compare ankle distraction arthroplasty versus supramalleolar osteotomy for post-traumatic ankle arthritis.MethodsThis retrospective study reviewed 32 consecutive patients who underwent surgery for post-traumatic ankle arthritis from January 2015 to December 2018 after failure of conservative treatment. Thirteen ankles that underwent ankle distraction arthroplasty were age-, sex-, and body mass index-matched with 19 ankles that underwent supramalleolar osteotomy. Patients returned for clinical and radiologic follow-up at an average of 32 (range, 24–48) months postoperatively. Outcomes were the comparison of the pre- and postoperative Visual Analog Scale (VAS) pain scores and American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, complications, subjective patient-rated satisfaction, and ankle function.ResultsThe VAS and AOFAS scores of the two groups were significantly improved at final follow-up compared with preoperatively (p<0.05), but did not significantly differ between groups. The ankle distraction arthroplasty group had better postoperative ankle mobility than the supramalleolar osteotomy group. There was no significant difference between the two groups in the tibial anterior surface angle, talar tilt angle, tibial lateral surface angle, and other imaging parameters, but supramalleolar osteotomy was more effective in correcting the load-bearing line of the ankle and hindfoot. The complication rate was similar in both groupsConclusionsAnkle distraction arthroplasty and supramalleolar osteotomy both achieved good pain relief and improved function in patients with traumatic ankle arthritis.Level of evidence: Level III, retrospective comparative series.

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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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Ankle Distraction Arthroplasty combined with PRP injection for Post-traumatic Ankle Arthritis

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00384 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0038

Author(s):

Zhongmin Shi ◽

Wenqi Gu

Keyword(s):

Ankle Joint ◽

Plantar Flexion ◽

Functional Limitation ◽

Ankle Arthrodesis ◽

Ankle Arthritis ◽

Distraction Arthroplasty ◽

Post Traumatic ◽

Pin Tract Infection ◽

American Orthopaedic ◽

Dorsal Extension

Category: Ankle Arthritis Introduction/Purpose: To summarize and evaluate the surgical technique and clinical outcome of ankle distraction arthroplasty with PRP injection for post-traumatic ankle arthritis. Methods: Totally 21 patients of post-traumatic ankle arthritis were treated at the department of orthopaedic surgery, Shanghai Sixth People’s Hospital. They were 13 males and 8 females with an average age of 32.5±6.2 years. The average course of disease were 14.0±2.8 months. After the failure of conservative management for at least 6 months, ankle distraction arthroplasty with PRP injection was performed in all patients. American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score system and Visual Analogue Scale (VAS) system were used to evaluate the final overall outcome. The range of motion (ROM) of ankle joint and complications were also recorded. Results: Pin tract infection was occurred in two patients, who were cured by alcohol care. 18 patients were followed for an average 36 months. The post-operative AOFAS ankle and hindfoot score was improved from 46.2±7.7 to 79.2±11.6 (t=-14.58, P ＜0.05), while the VAS score was decreased from 6.6±1.1 to 1.8±2.0 (t=16.424, P＜0.0001). The dorsal extension of ankle joint was increased from 1.3±9.3° to 8.1±5.5° (t=-4.675, P＜0.0001) and the plantar flexion was improved from 14.4±6.8° to 26.9±7.3°(t=-7.919, P＜0.05). The radiograph manifested the progressive course of ankle arthritis in four patients, two of which were cured by a salvage ankle arthrodesis by consequence of a failure of conservative treatment for persistent pain and functional limitation. Conclusion: The ankle distraction arthroplasty is an effective ankle preserving surgery, which could relieve symptoms, improve functions and delay the course of post-traumatic ankle arthritis

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Ankle distraction arthroplasty using the Ilizarov external fixation and arthroscopy: first clinical experience

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-1-92-96 ◽

2021 ◽

Vol 27 (1) ◽

pp. 92-96

Author(s):

S.S. Leonchuk ◽

◽

L.A. Ostrovskikh ◽

N.V. Sazonova ◽

◽

...

Keyword(s):

Exercise Therapy ◽

Sport Injury ◽

Surgical Intervention ◽

Comprehensive Treatment ◽

Ankle Arthritis ◽

Distraction Arthroplasty ◽

Ilizarov Apparatus ◽

And Function ◽

Combined Technique

We report a clinical case of a 27-year-old patient with posttraumatic painful ankle arthritis following sport injury treated with combined methods. The patient underwent ankle distraction arthroplasty with original Ilizarov apparatus and arthroscopic diagnosis and treatment of the ankle injury followed by the joint unloading and exercise therapy with frame on performed for 6 weeks at the Kurgan Ilizarov Center. The patient could improve pain relief and function at a long term following comprehensive treatment including surgical intervention, a course of physical procedures and exercise therapy. The combined technique can be used as an alternative treatment for patients with posttraumatic ankle arthritis.

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