Supramalleolar osteotomy in post-traumatic valgus ankle osteoarthritis

• Published in: International orthopaedics 2020-03, Vol.44 (3), p.535-543
• Main Authors: Krähenbühl, Nicola, Susdorf, Roman, Barg, Alexej, Hintermann, Beat
• Format: Article
• Language: English
• Subjects: Adult; Ankle Injuries - complications; Ankle Injuries - diagnostic imaging; Ankle Joint - diagnostic imaging; Ankle Joint - surgery; Female; Fibula - diagnostic imaging; Fibula - surgery; Humans; Male; Medicine; Medicine & Public Health; Original Paper; Orthopedics; Osteoarthritis - diagnostic imaging; Osteoarthritis - etiology; Osteoarthritis - surgery; Osteotomy - methods; Retrospective Studies; Young Adult
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-019-04476-x

Purpose To assess how the level of the deformity, the stage of the osteoarthritic process, and the role of additional surgeries impact radiographic and clinical outcomes following an extra-articular medial closing supramalleolar osteotomy for treatment of post-traumatic valgus ankle osteoarthritis. Methods About 56 consecutive patients who underwent an extra-articular medial closing wedge osteotomy for post-traumatic valgus ankle osteoarthritis were retrospectively analyzed. Subgroups were formed according to the pre-operative level of deformity and preoperative stage of ankle osteoarthritis. Additional surgical steps required to achieve a properly balanced hindfoot were also noted. Radiographic and clinical outcomes of each subgroup were compared with each other, and the role of additional surgical steps required to achieve a balanced hindfoot was investigated. Results Radiographic and clinical outcomes improved significantly between pre-operative assessment and the last follow-up. Patients with a pre-operative supramalleolar deformity showed superior radiographic outcomes compared to patients with an intra-articular deformity. Clinical outcomes did not differ significantly between these two subgroups. The pre-operative stage of ankle osteoarthritis significantly impacted radiographic outcomes but did not influence clinical outcome measures. An additional fibula or calcaneus osteotomy was necessary for 55% and 23% of all patients, respectively. Conclusion Extra-articular medial closing supramalleolar osteotomies show satisfactory mid- to long-term radiographic and clinical outcomes in patients with post-traumatic valgus ankle osteoarthritis.