Background: Our study evaluated the short-term clinical and radiographic results of total ankle arthroplasty (TAA) with combined bony reconstructions for treatment of end-stage ankle osteoarthritis with accompanying cavovarus/hindfoot varus deformities. Methods: This study included 8 patients (10 ankles) with ankle osteoarthritis (OA) who were treated by TAA with combined calcaneal and metatarsal osteotomies between September 2004 and June 2010 and were followed an average of 17.9 months (12-43 months). Visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, radiographic measurements, and patient satisfaction were evaluated. Results: The average patient age was 66.2 years (range, 55-76 years). Eighteen bony reconstruction procedures such as lateral sliding calcaneal osteotomy (n = 9) and first metatarsal dorsiflexion osteotomy (n = 4) were performed in addition to TAA. VAS pain score improved from an average of 8.8 (range, 6-10) preoperatively to an average of 2.4 (range, 0-7) (P < .05), and the AOFAS score improved from 36.9 (range, 14-71) preoperatively to 89.3 (range, 68-100) (P < .05). Ninety percent of the patients were satisfied with the results. Radiographically, the tibiocalcaneal angle (TCA) improved from a preoperative average of 19.0 degrees (range, 13-23 degrees) to 0.2 degrees (range, -5.4 to 2.8 degrees), the tibial axis-talar dome angle (TA-TDA) improved from a preoperative average of 15.6 degrees (range, 11.1-18.0 degrees) to 3.3 degrees (range, 1.7-5.6 degrees), and the talar dome-ground surface angle (TD-GSA) improved from a preoperative average of 21.2 degrees (range, 15.4-27.5 degrees) to 5.1 degrees (range, 1.8-10.2 degrees) (P < .05). Conclusion: We found that it was occasionally necessary to perform combined calcaneal and metatarsal osteotomies with TAA in order to successfully treat ankle OA with an accompanying cavovarus/varus deformity. The TD-GSA and TCA were also found to be important radiographic parameters in assessing varus ankles. Level of Evidence: IV, retrospective case series.
[Show abstract][Hide abstract] ABSTRACT: Trauma, such as ankle fractures, has been the major etiology of ankle arthritis. It has been reported that 70-80% of ankle arthritis cases are due to lateral ankle instability and post-traumatic ankle arthritis. Ankle arthrodesis is the gold standard for end-stage ankle arthritis treatment, but it restricts ankle motion and leads to adjacent joint arthritis in the long term. Low tibial osteotomy is indicated for unicompartmental ankle osteoarthritis (OA) with varus/valgus deformity to realign the malalignment and redistribute the localized tibial plafond and malleolar pressure upon the talus and relieve ankle pain. Ankle distraction arthroplasty is another option for young patients with early ankle OA to widen the ankle joint space and decrease pain. Total ankle arthroplasty (TAA) is a viable surgical alternative for end-stage ankle OA to relieve ankle pain while preserving ankle motion. Recently, a 3-component total ankle system has been predominant, and the outcomes and survival of TAA have improved somewhat. Prospective comparative studies on ankle arthrodesis and TAA should be performed in the future, especially with critical evaluation of complications. Ankle arthrodesis and TAA are 2 major surgical options for end-stage ankle arthritis, but research on other possible alternatives for early stage OA should be performed in the future.
Journal of the Korean Medical Association 10/2013; 56(10):908. DOI:10.5124/jkma.2013.56.10.908 · 0.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The study was performed to investigate the influence of a one step calcaneal osteotomy on the outcome of total ankle replacement, especially complication rate, rehabilitation, as well as early and midterm results.
15 consecutive patients with varus arthritis underwent total ankle replacement and calcaneal osteotomy and were compared to an age and bodyweight matched control group. The analysis included the AOFAS hindfoot score preoperative, 3, 6, 12 and 24 months postoperative. The radiological follow up was analyzed as well as complications and revisions.
The preoperative AOFAS score was 41(Range: 22-69) in the control group, in the group with hindfoot deformity it was with 35 (Range 26-52) significant lower. Joint function was significant improved in both groups by total ankle replacement. Already 3 months postoperative results of the two groups converged, after 12 months there was no more statistical difference. It took 24 months for patients with hindfoot correction to reach similar satisfaction values as patients from the control group. The adjacent procedures did not cause an increase in complications or revisions; however rehabilitation was somehow longer after hindfoot osteotomy.
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