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

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.

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

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

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

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

scholarly journals Comparison of Treatment between Distal Tibial Osteotomy without Fibular Osteotomy and Tibiotalar Arthrodesis for Medial Ankle Arthritis in Older Individuals

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Koji Nozaka ◽  
Takeshi Kashiwagura ◽  
Hideji Kura
Keyword(s):  
Physical Component Score ◽  
Tibial Osteotomy ◽  
Older Individuals ◽  
Ankle Arthritis ◽  
Ankle Osteoarthritis ◽  
Component Score ◽  
Sf 36 ◽  
Circular External Fixator ◽  
Tibiotalar Arthrodesis ◽  
The Mean

Category: Ankle Arthritis Introduction/Purpose: Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. Distal tibial osteotomy without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years, but patient satisfaction has yet to be compared between the two treatments. Objective: To compare distal tibial osteotomy and tibiotalar arthrodesis for ankle osteoarthritis (stage IIIb and above under the Takakura classification) in older individuals. Methods: Subjects and Method: A total of 35 patients aged>60 years old who showed medial ankle arthritis were examined. Patients were either treated with tibiotalar arthrodesis (n=18) or distal tibial osteotomy (n=17). The patients’ mean age was 72.1 years (range, 60–81 years) in the tibiotalar arthrodesis group and 67.2 years (range, 60–80 years) in the distal tibial osteotomy group. For distal tibial osteotomy, a circular external fixator was used in all cases. Osteotomy was performed after performing synovectomy and microfracture surgery using ankle arthroscopy. At the time of fixation with a circular external fixator, foot ring (calcaneal) fixation was also performed. In addition, joint distraction was performed, and distraction arthroplasty was also simultaneously performed. Results: The mean preoperative VAS score was 8.2 for tibiotalar arthrodesis (TA) and 8.0 for distal tibial osteotomy (DTO). The mean postoperative VAS score was 1.9 for TA and 1.7 for DTO. The mean preoperative AOFAS score was 40.1 for TA and 43.1 for DTO. The mean postoperative AOFAS score was 86.2 for TA and 90.0 for DTO. The mean preoperative SF-36 physical component score was 30.5 for TA and 38.5 for DTO. The mean preoperative SF-36 mental component score was 33.5 for TA and 37.5 for DTO. The mean postoperative SF-36 physical component score was 42.5 for TA and 56.4 for DTO. It was significantly higher with the DTO (p<0.05). Conclusion: The mean postoperative SF-36 mental component score was 44.0 for TA and 59.7 for DTO. It was significantly higher with the DTO (p<0.05).Superior SF-36 scores were obtained for DTO compared to TA. The fact that the Japanese lifestyle involves tatami mats was thought to have contributed to the superiority of DTO in patient satisfaction.

scholarly journals Realignment Surgery for Anterior Translation of Talus after Malunited Ankle Fracture

2019 ◽  
Author(s):  
Xingchen Li ◽  
Kai Rong ◽  
Yang Xu ◽  
Yuan Zhu ◽  
Xiangyang Xu
Keyword(s):  
Soft Tissue ◽  
Ankle Joint ◽  
Ankle Fracture ◽  
Sagittal Plane ◽  
Tibial Osteotomy ◽  
Ankle Osteoarthritis ◽  
Anterior Translation ◽  
Functional Scores ◽  
Weber Type ◽  
The Mean

Abstract Background: It is challenging for the clinical management of malunited ankle fracture. The aim of this study is to evaluate the clinical outcome of realignment surgery for anterior translation of talus after malunited ankle fracture and to analyze its. Methods: A total of 11 patients with anterior translation of talus after malunited ankle fractures underwent corrective osteotomy in our institute were retrospectively reviewed. All patients were evaluated with radiological parameters and clinical functional scores. There were 4 patients with Weber type A fracture, 4 patients with Pilon type B fracture and 3 patients with Weber type C fracture. 8/11 patients had impaction on the anterior distal tibial plafond, intra-articular distal tibial osteotomy was performed in these patients, additional bony correction and soft tissue surgery were also performed to achieve congruent ankle joint. Results: The mean age at surgery was 32.8 ± 10.8 (range,16-48) years. The mean follow-up time was 50.5 ± 23.6 (range, 16-80) months. The mean AOFAS-AH score increased from 28.2 ± 19.1preoperatively to 72.5 ± 8.1 points postoperatively(p<0.05), the mean lateral talar station(LTS) improved from 9.2 ± 3.7 preoperatively to 1.5 ± 1.4 mm postoperatively(p<0.05). 10/11 patients had improvement or no worsening ankle osteoarthritis on sagittal plane, while 1 patient had advanced ankle osteoarthritis. Conclusion: A congruent ankle joint in sagittal plane could be achieved by corrective osteotomies with additional soft tissue procedures. The realignment surgery was a valuable treatment option for the salvage of anterior translation of talus after malunited ankle fracture.

Ankle Joint Distraction Arthroplasty

2013 ◽  
Vol 18 (3) ◽  
pp. 459-470 ◽  
Author(s):  
Alexej Barg ◽  
Annunziato Amendola ◽  
Douglas N. Beaman ◽  
Charles L. Saltzman
Keyword(s):  
Ankle Joint ◽  
Distraction Arthroplasty ◽  
Joint Distraction

scholarly journals Functional Analysis of Distraction Arthroplasty in the Treatment of Ankle Osteoarthritis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0049
Author(s):  
Liang Xiaojun ◽  
Zhao Hong-Mou
Keyword(s):  
Ankle Joint ◽  
Failure Rate ◽  
Functional Outcomes ◽  
Joint Space ◽  
Ankle Osteoarthritis ◽  
Distraction Arthroplasty ◽  
Significant Difference ◽  
And Gender ◽  
American Orthopaedic ◽  
Relative Factors

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.

Long-term results of the subtubercle tibial osteotomy using the circular external fixator for medı̇al compartment osteoarthrı̇tı̇s of knee

The Knee ◽  
2022 ◽  
Vol 34 ◽  
pp. 147-155
Author(s):  
Orhan Balta ◽  
Mehmet Burtaç Eren ◽  
Tahir Öztürk ◽  
Harun Altınayak
Keyword(s):  
External Fixator ◽  
Long Term Results ◽  
Tibial Osteotomy ◽  
Circular External Fixator

scholarly journals Arthroscopic Findings of the Joint Distraction for the Patient With Chondrolysis of the Ankle

1997 ◽  
Vol 4 (2) ◽  
pp. 101-105 ◽  
Author(s):  
Katsuaki Kanbe ◽  
Atsushi Hasegawa ◽  
Kenji Takagishi ◽  
Hiroyuki Kaneko ◽  
Yasuyuki Nakajima
Keyword(s):  
Case Report ◽  
Ankle Joint ◽  
External Fixator ◽  
Articular Surfaces ◽  
Arthroscopic Findings ◽  
Joint Distraction

This case report describes arthroscopic findings of the effect on articular distraction of ankle joint by means of external fixator for the patient with chondrolysis. Arthroscopy showed fibrocartilage tissue lying between the talus and tibia to protect damaged articular surfaces although apparent repair of surface cartilage failed to find.

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

2020 ◽  
Vol 21 (1) ◽  
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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