Modified distal tibial oblique osteotomy for osteoarthritis of the ankle: Operative procedure and preliminary results.
Aged
Ankle Joint
/ diagnostic imaging
Bone Plates
Female
Humans
Male
Middle Aged
Osteoarthritis
/ diagnostic imaging
Osteotomy
/ methods
Pain Measurement
Prognosis
Range of Motion, Articular
/ physiology
Risk Assessment
Sampling Studies
Severity of Illness Index
Tibia
/ diagnostic imaging
Treatment Outcome
Weight-Bearing
/ physiology
Journal
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
ISSN: 1436-2023
Titre abrégé: J Orthop Sci
Pays: Japan
ID NLM: 9604934
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
received:
02
02
2017
revised:
23
04
2018
accepted:
29
08
2018
pubmed:
25
9
2018
medline:
25
7
2019
entrez:
25
9
2018
Statut:
ppublish
Résumé
Low tibial osteotomy is an effective joint-preserving surgery for ankle arthritis. However, poor postoperative wound healing, infection, and delayed or non-union of bones remain significant concerns. We describe a modified distal tibial oblique osteotomy procedure and report preliminary results for varus ankle arthritis. The osteotomy path consisted of an oblique doglegged line from the lateral end of the distal tibia to a proximal point about one-third from the lateral edge and continuing along an arc defined by virtual coronal-plane rotation of the doglegged line to the medial edge. After osteotomy, the distal tibial fragment was rotated distally in the coronal plane for realignment while maintaining contact with the proximal tibia and the distal tibial fragment. The resulting wedge-shaped gap was filled with artificial bone blocks and tibial bone projecting medially from rotation. A locking plate was then applied for stabilization. We evaluated 7 ankles from 6 osteoarthritis patients both clinically and radiographically following this procedure. Bone union was achieved within 3 months for all patients. The Japanese Society for Surgery of the Foot ankle-hindfoot scale improved from a mean of 38.4 points preoperatively to 85.7 points at the latest follow-up. No wound healing problems, infections, or nerve disturbances were observed. Multiple radiographic parameters were also improved following the operation. This procedure maintains close bone contact for better postoperative union, obviates the need for iliac bone harvesting, and reduces tension on medial soft tissue. We believe these modifications are potential advantages for achieving stable results in patients with ankle osteoarthritis.
Sections du résumé
BACKGROUND
BACKGROUND
Low tibial osteotomy is an effective joint-preserving surgery for ankle arthritis. However, poor postoperative wound healing, infection, and delayed or non-union of bones remain significant concerns. We describe a modified distal tibial oblique osteotomy procedure and report preliminary results for varus ankle arthritis.
METHODS
METHODS
The osteotomy path consisted of an oblique doglegged line from the lateral end of the distal tibia to a proximal point about one-third from the lateral edge and continuing along an arc defined by virtual coronal-plane rotation of the doglegged line to the medial edge. After osteotomy, the distal tibial fragment was rotated distally in the coronal plane for realignment while maintaining contact with the proximal tibia and the distal tibial fragment. The resulting wedge-shaped gap was filled with artificial bone blocks and tibial bone projecting medially from rotation. A locking plate was then applied for stabilization. We evaluated 7 ankles from 6 osteoarthritis patients both clinically and radiographically following this procedure.
RESULTS
RESULTS
Bone union was achieved within 3 months for all patients. The Japanese Society for Surgery of the Foot ankle-hindfoot scale improved from a mean of 38.4 points preoperatively to 85.7 points at the latest follow-up. No wound healing problems, infections, or nerve disturbances were observed. Multiple radiographic parameters were also improved following the operation.
CONCLUSIONS
CONCLUSIONS
This procedure maintains close bone contact for better postoperative union, obviates the need for iliac bone harvesting, and reduces tension on medial soft tissue. We believe these modifications are potential advantages for achieving stable results in patients with ankle osteoarthritis.
Identifiants
pubmed: 30245094
pii: S0949-2658(18)30244-6
doi: 10.1016/j.jos.2018.08.020
pii:
doi:
Types de publication
Journal Article
Langues
eng
Pagination
306-311Informations de copyright
Copyright © 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.