Joint-Preserving Surgery in Varus Ankle Osteoarthritis

Abstract

Ankle deformity is a disabling condition especially if concomitant with osteoarthritis (OA). Varus ankle OA is one of the most common ankle OA deformities. This deformity usually leads to unequal load distribution in the ankle joint and decreases joint contact surface area, leading to a progressive degenerative arthritic situation. Varus ankle OA might have multiple causative factors, which might present as a single isolated factor or encompassed together in a single patient. The etiologies can be classified as post-traumatic (e.g., after fractures and lateral ligament instability), degenerative, systemic, neuromuscular, congenital, and others. Treatment options are determined by the degree of the deformity and analyzing the pathology, which range from the conservative treatments up to surgical interventions. Surgical treatment of the varus ankle OA can be classified into two categories, joint-preserving surgery (JPS) and joint-sacrificing surgery (JSS) as total ankle arthroplasty and ankle arthrodesis. JPS is a valuable treatment option in varus ankle OA, which should not be neglected since it has showed a promising result, optimizing biomechanics and improving the survivorship of the ankle joint.

Keywords: ankle osteoarthritis; joint preserving surgery; supramalleolar osteotomy; varus ankle.

Figure 1

Angles for the Radiological Evaluation of a Varus Ankle Osteoarthritis. On the anteroposterior view, tibial anterior surface angle TAS (also known as medial distal tibial angle MDTA) tibiotalar surface (TTS) and talar tilt (TT) angle are shown (A). On lateral ankle radiograph, the tibial lateral surface angle (TLS) is assessed (B). The talar-1st metatarsal angle gives us a hint about the amount of midfoot deformity, both on lateral and dorsoplantar view (B,C). Inframalleolar deformity can be evaluated on the Saltzman view by measuring the hindfoot alignment view (HAV) angle (D).

Figure 1

Angles for the Radiological Evaluation of a Varus Ankle Osteoarthritis. On the anteroposterior view, tibial anterior surface angle TAS (also known as medial distal tibial angle MDTA) tibiotalar surface (TTS) and talar tilt (TT) angle are shown (A). On lateral ankle radiograph, the tibial lateral surface angle (TLS) is assessed (B). The talar-1st metatarsal angle gives us a hint about the amount of midfoot deformity, both on lateral and dorsoplantar view (B,C). Inframalleolar deformity can be evaluated on the Saltzman view by measuring the hindfoot alignment view (HAV) angle (D).

Figure 2

Chronic Painful Posttraumatic Varus Ankle Osteoarthritis (OA) with Medial Degeneration of the Ankle Joint with Pes Planus Foot. In this case, there was preoperative a varus ankle OA with a hindfoot varus and a rare concomitant flatfoot at the midfoot (A–D). A complex reconstruction was performed (E–H): Supramalleolar lateral closing wedge osteotomy of the tibia (Anatomical Anterolateral Tibial Plate Aptus, Medartis, Basel, Switzerland), fibular shortening osteotomy (Anatomical Fibular Aptus Plate, Medartis, Basel, Switzerland), anteromedial osteophytes removal/cheilectomy, lateral ankle ligament repair, and Deltoid release. Note that a midfoot Cotton osteotomy (Cotton-Plate with Titanium Wedge, Medartis, Basel, Switzerland) was performed in order to counteract the pre-existing flatfoot deformity.

Figure 2

Chronic Painful Posttraumatic Varus Ankle Osteoarthritis (OA) with Medial Degeneration of the Ankle Joint with Pes Planus Foot. In this case, there was preoperative a varus ankle OA with a hindfoot varus and a rare concomitant flatfoot at the midfoot (A–D). A complex reconstruction was performed (E–H): Supramalleolar lateral closing wedge osteotomy of the tibia (Anatomical Anterolateral Tibial Plate Aptus, Medartis, Basel, Switzerland), fibular shortening osteotomy (Anatomical Fibular Aptus Plate, Medartis, Basel, Switzerland), anteromedial osteophytes removal/cheilectomy, lateral ankle ligament repair, and Deltoid release. Note that a midfoot Cotton osteotomy (Cotton-Plate with Titanium Wedge, Medartis, Basel, Switzerland) was performed in order to counteract the pre-existing flatfoot deformity.