SLR - December 2023 - Akbarzai
Title: Comparisons between ankle distraction arthroplasty and supramalleolar osteotomy for treatment of post-traumatic varus ankle osteoarthritisReference: Yang Z, Cui L, Tao S, Zhao J, Wang L, Zhang F, Shao X. Comparisons between ankle distraction arthroplasty and supramalleolar osteotomy for treatment of post-traumatic varus ankle osteoarthritis. BMC Surg. 2022 May 14;22(1):178.
Level of Evidence: Level 3
Reviewed By: Henna Akbarzai, PGY-2
Residency Program: St. Mary’s General Hospital, Passaic, NJ
Podiatric Relevance: Ankle osteoarthritis is a common pathology managed by foot and ankle surgeons. This condition can present itself during different stages of pathology. For stage 3 post traumatic varus ankle arthritis (VAA), there is no consensus over an optimal surgical treatment option. In an attempt to delay progression of arthritis and neutralize abnormal ankle joint forces, joint salvage surgical procedures are performed. The authors of this study present ankle distraction arthroplasty and supramalleolar osteotomy as two options to evaluate further. This study can prove to be helpful in selecting the most appropriate surgical procedure for patient’s as viable treatment options to restore function for patients with VAA.
Methods: This study retrospectively evaluated 73 patients with Takakura-Tanaka stage 3 post traumatic VAA who were either treated with ankle distraction arthroplasty (n=32) or a medial opening wedge supramalleolar osteotomy (n=41). To perform the ankle distraction arthroplasty, an external fixator was applied to expand the joint cavity by 0.5 cm every 12 hours until 5 mm of arthrodiastasis is achieved. Outcome measurements were collected at 1, 3, 6, 12, and 24 months postoperatively and included comparing American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scores, Visual Analogue Scale (VAS) scores, tibial anterior surface (TAS) angle, tibial lateral surface (TLS) angle, talar tilt (TT) angle, and range of motion.
Results: When comparing the two surgical procedures, ankle distraction arthroplasty and supramalleolar osteotomy, the operative time was 78 minutes and 94 minutes respectively. Significant improvement compared to preoperative baseline parameters were noted for both groups in AOFAS scores and VAS scores. Ankle distraction arthroplasty group had significantly improved ankle joint range of motion compared to the supramalleolar group. Significant improvement in TAS angle and TT angle was only noted in the supramalleolar osteotomy group. No significant difference was noted for TLS angle for either group. No difference in complication prevalence was noted between both groups. Excellent and good ratings were collected by 78.1% of the ankle distraction arthroplasty group and 85.4% of the supramalleolar osteotomy group.
Conclusions: This study retrospectively analyzed clinical, functional, and radiographic outcomes of two procedures for stage 3 post traumatic VAA. The authors concluded that supramalleolar osteotomies were superior to distraction arthroplasties due to the ability of the osteotomy to correct the load line of the ankle and hindfoot, the distal tibial deformity in both the coronal and sagittal planes, and the talar tilt. Supramalleolar osteotomies in this study successfully restored the lower extremity limb alignment when compared to distraction arthroplasty. Both joint salvage ankle procedures are useful tools for the foot and ankle surgeon to have in their armamentarium. This article highlights that after radiographic and biomechanical work up, the optimal procedure for a patient with stage 3 VAA can be decided. Distraction arthroplasties are useful for patients with minimal varus deformity and offer a solution without the need to heal an osteotomy while SMO realign surfaces and neutralize joint forces. These considerations allow the surgeon to be comfortable in selecting the appropriate treatment option in VAA.