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01-09-2013 | Review Article

Supramalleolar osteotomies for degenerative joint disease of the ankle joint: indication, technique and results

Authors: Alexej Barg, Geert I. Pagenstert, Monika Horisberger, Jochen Paul, Marcel Gloyer, Heath B. Henninger, Victor Valderrabano

Published in: International Orthopaedics | Issue 9/2013

Abstract

Patients with varus or valgus hindfoot deformities usually present with asymmetric ankle osteoarthritis. In-vitro biomechanical studies have shown that varus or valgus hindfoot deformity may lead to altered load distribution in the tibiotalar joint which may result in medial (varus) or lateral (valgus) tibiotalar joint degeneration in the short or medium term. The treatment of asymmetric ankle osteoarthritis remains challenging, because more than half of the tibiotalar joint surface is usually preserved. Therefore, joint-sacrificing procedures like total ankle replacement or ankle arthrodesis may not be the most appropriate treatment options. The short- and midterm results following realignment surgery, are very promising with substantial pain relief and functional improvement observed post-operatively. In this review article we describe the indications, surgical techniques, and results from of realignment surgery of the ankle joint in the current literature.

Glazebrook M, Daniels T, Younger A, Foote CJ, Penner M, Wing K, Lau J, Leighton R, Dunbar M (2008) Comparison of health-related quality of life between patients with end-stage ankle and hip arthrosis. J Bone Joint Surg Am 90(3):499–505PubMedCrossRef

Buckwalter JA, Saltzman C, Brown T (2004) The impact of osteoarthritis: implications for research. Clin Orthop Relat Res (427 Suppl):S6–S15

Horváth G, Than P, Bellyei A, Kranicz J, Illés T (2006) Prevalence of degenerative joint complaints of the lower extremity: a representative study. Int Orthop 30(2):118–122PubMedCrossRef

Horisberger M, Hintermann B, Valderrabano V (2009) Alterations of plantar pressure distribution in posttraumatic end-stage ankle osteoarthritis. Clin Biomech (Bristol, Avon) 24(3):303–307CrossRef

Horisberger M, Valderrabano V, Hintermann B (2009) Posttraumatic ankle osteoarthritis after ankle-related fractures. J Orthop Trauma 23(1):60–67PubMedCrossRef

Knupp M, Stufkens SA, Bolliger L, Barg A, Hintermann B (2011) Classification and treatment of supramalleolar deformities. Foot Ankle Int 32:1023–1031PubMedCrossRef

Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B (2009) Etiology of ankle osteoarthritis. Clin Orthop Relat Res 467(7):1800–1806PubMedCrossRef

Ogilvie-Harris DJ, Sekyi-Otu A (1995) Arthroscopic debridement for the osteoarthritic ankle. Arthroscopy 11(4):433–436PubMedCrossRef

Saltzman CL, Hillis SL, Stolley MP, Anderson DD, Amendola A (2012) Motion versus fixed distraction of the joint in the treatment of ankle osteoarthritis: a prospective randomized controlled trial. J Bone Joint Surg Am 94(11):961–970PubMedCrossRef

10.

Wiewiorski M, Barg A, Valderrabano V (2013) Cartilage reconstruction in osteochondral lesions of the talus (OCLT). Foot Ankle Clin (accepted for publication)

11.

Tanaka Y (2012) The concept of ankle joint preserving surgery: why does supramalleolar osteotomy work and how to decide when to do an osteotomy or joint replacement. Foot Ankle Clin 17(4):545–553PubMedCrossRef

12.

Ahmad J, Raikin SM (2008) Ankle arthrodesis: the simple and the complex. Foot Ankle Clin 13(3):381–400PubMedCrossRef

13.

Barg A, Knupp M, Henninger HB, Zwicky L, Hintermann B (2012) Total ankle replacement using HINTEGRA, an unconstrained, three-component system: surgical technique and pitfalls. Foot Ankle Clin 17(4):607–635PubMedCrossRef

14.

Valderrabano V, Pagenstert GI, Müller AM, Paul J, Henninger HB, Barg A (2012) Mobile- and fixed-bearing total ankle prostheses: is there really a difference? Foot Ankle Clin 17(4):565–585PubMedCrossRef

15.

Coester LM, Saltzman CL, Leupold J, Pontarelli W (2001) Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am 83-A(2):219–228PubMed

16.

Glazebrook MA, Ganapathy V, Bridge MA, Stone JW, Allard JP (2009) Evidence-based indications for ankle arthroscopy. Arthroscopy 25(12):1478–1490PubMedCrossRef

17.

Haddad SL, Coetzee JC, Estok R, Fahrbach K, Banel D, Nalysnyk L (2007) Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature. J Bone Joint Surg Am 89(9):1899–1905PubMedCrossRef

18.

Brown TD, Johnston RC, Saltzman CL, Marsh JL, Buckwalter JA (2006) Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. J Orthop Trauma 20(10):739–744PubMedCrossRef

19.

Egloff C, Hügle T, Valderrabano V (2012) Biomechanics and pathomechanisms of osteoarthritis. Swiss Med Wkly 142:w13583. doi:10.4414/smw.2012.13583

20.

Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, Amendola A (2005) Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J 25:44–46PubMed

21.

Stufkens SA, Knupp M, Horisberger M, Lampert C, Hintermann B (2010) Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures: a prospective study. J Bone Joint Surg Am 92(2):279–286PubMedCrossRef

22.

Hintermann B, Boss A, Schäfer D (2002) Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med 30(3):402–409PubMed

23.

Valderrabano V, Hintermann B, Horisberger M, Fung TS (2006) Ligamentous posttraumatic ankle osteoarthritis. Am J Sports Med 34(4):612–620PubMedCrossRef

24.

Lübbeke A, Salvo D, Stern R, Hoffmeyer P, Holzer N, Assal M (2012) Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study. Int Orthop 36(7):1403–1410PubMedCrossRef

25.

Easley ME (2012) Surgical treatment of the arthritic varus ankle. Foot Ankle Clin 17(4):665–686PubMedCrossRef

26.

Barg A, Pagenstert GI, Leumann AG, Müller AM, Henninger HB, Valderrabano V (2012) Treatment of the arthritic valgus ankle. Foot Ankle Clin 17(4):647–663PubMedCrossRef

27.

Valderrabano V, Miska M, Leumann A, Wiewiorski M (2013) Reconstruction of osteochondral lesions of the talus with autologous spongiosa grafts and autologous matrix-induced chondrogenesis. Am J Sports Med 41(3):519–527PubMedCrossRef

28.

Barg A, Elsner A, Anderson AE, Hintermann B (2011) The effect of three-component total ankle replacement malalignment on clinical outcome: pain relief and functional outcome in 317 consecutive patients. J Bone Joint Surg Am 93(21):1969–1978PubMedCrossRef

29.

Cenni F, Leardini A, Cheli A, Catani F, Belvedere C, Romagnoli M, Giannini S (2012) Position of the prosthesis components in total ankle replacement and the effect on motion at the replaced joint. Int Orthop 36(3):571–578PubMedCrossRef

30.

Espinosa N, Walti M, Favre P, Snedeker JG (2010) Misalignment of total ankle components can induce high joint contact pressures. J Bone Joint Surg Am 92(5):1179–1187PubMedCrossRef

31.

Lee JJ, Patel R, Biermann JS, Dougherty PJ (2013) The musculoskeletal effects of cigarette smoking. J Bone Joint Surg Am 95(9):850–859PubMedCrossRef

32.

Saltzman CL, el-Khoury GY (1995) The hindfoot alignment view. Foot Ankle Int 16(9):572–576PubMedCrossRef

33.

Knupp M, Pagenstert GI, Barg A, Bolliger L, Easley ME, Hintermann B (2009) SPECT-CT compared with conventional imaging modalities for the assessment of the varus and valgus malaligned hindfoot. J Orthop Res 27(11):1461–1466PubMedCrossRef

34.

Pagenstert GI, Barg A, Leumann AG, Rasch H, Müller-Brand J, Hintermann B, Valderrabano V (2009) SPECT-CT imaging in degenerative joint disease of the foot and ankle. J Bone Joint Surg Br 91(9):1191–1196PubMed

35.

Kretzschmar M, Wiewiorski M, Rasch H, Jacob AL, Bilecen D, Walter MA, Valderrabano V (2011) 99mTc-DPD-SPECT/CT predicts the outcome of imaging-guided diagnostic anaesthetic injections: a prospective cohort study. Eur J Radiol 80(3):e410–e415PubMedCrossRef

36.

Knupp M, Ledermann H, Magerkurth O, Hintermann B (2005) The surgical tibiotalar angle: a radiologic study. Foot Ankle Int 26(9):713–716PubMed

37.

Inman VT (1976) The joints of the ankle. Williams & Wilkins, Baltimore

38.

Stufkens SA, Barg A, Bolliger L, Stucinskas J, Knupp M, Hintermann B (2011) Measurement of the medial distal tibial angle. Foot Ankle Int 32:288–293PubMedCrossRef

39.

Barg A, Harris MD, Henninger HB, Amendola RL, Saltzman CL, Hintermann B, Anderson AE (2012) Medial distal tibial angle: comparison between weightbearing mortise view and hindfoot alignment view. Foot Ankle Int 33(8):655–661PubMedCrossRef

40.

Tanaka Y, Takakura Y, Fujii T, Kumai T, Sugimoto K (1999) Hindfoot alignment of hallux valgus evaluated by a weightbearing subtalar x-ray view. Foot Ankle Int 20(10):640–645PubMedCrossRef

41.

Cox JS, Hewes TF (1979) “Normal” talar tilt angle. Clin Orthop Relat Res 140:37–41PubMed

42.

Knupp M, Barg A, Bolliger L, Hintermann B (2012) Reconstructive surgery for overcorrected clubfoot in adults. J Bone Joint Surg Am 94(15):e1101–e1107PubMed

43.

Warnock KM, Johnson BD, Wright JB, Ambrose CG, Clanton TO, McGarvey WC (2004) Calculation of the opening wedge for a low tibial osteotomy. Foot Ankle Int 25(11):778–782PubMed

44.

Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757PubMed

45.

Chu A, Weiner L (2009) Distal fibula malunions. J Am Acad Orthop Surg 17(4):220–230PubMed

46.

Thordarson DB, Motamed S, Hedman T, Ebramzadeh E, Bakshian S (1997) The effect of fibular malreduction on contact pressures in an ankle fracture malunion model. J Bone Joint Surg Am 79(12):1809–1815PubMed

47.

Hintermann B, Barg A, Knupp M (2011) Corrective supramalleolar osteotomy for malunited pronation-external rotation fractures of the ankle. J Bone Joint Surg Br 93(10):1367–1372PubMed

48.

Weber BG, Simpson LA (1985) Corrective lengthening osteotomy of the fibula. Clin Orthop Relat Res 199(199):61–67PubMed

49.

Hintermann B, Valderrabano V (2003) Lateral column lengthening by calcaneal osteotomy. Tech Foot Ankle 2:84–90CrossRef

50.

Hintermann B, Valderrabano V, Kundert HP (1999) Lengthening of the lateral column and reconstruction of the medial soft tissue for treatment of acquired flatfoot deformity associated with insufficiency of the posterior tibial tendon. Foot Ankle Int 20(10):622–629CrossRef

51.

Dolan CM, Henning JA, Anderson JG, Bohay DR, Kornmesser MJ, Endres TJ (2007) Randomized prospective study comparing tri-cortical iliac crest autograft to allograft in the lateral column lengthening component for operative correction of adult acquired flatfoot deformity. Foot Ankle Int 28(1):8–12PubMedCrossRef

52.

Grier KM, Walling AK (2010) The use of tricortical autograft versus allograft in lateral column lengthening for adult acquired flatfoot deformity: an analysis of union rates and complications. Foot Ankle Int 31(9):760–769PubMedCrossRef

53.

Knupp M, Pagenstert G, Valderrabano V, Hintermann B (2008) Osteotomies in varus malalignment of the ankle. Oper Orthop Traumatol 20(3):262–273PubMedCrossRef

54.

Barg A, Pagenstert G, Leumann A, Valderrabano V (2013) Malleolar osteotomy—osteotomy as approach. Orthopade 42(5):309–321PubMedCrossRef

55.

Knupp M, Stufkens SA, Pagenstert G, Hintermann B, Valderrabano V (2009) Supramalleolar osteotomy for tibiotalar varus malalignment. Tech Foot Ankle 8:17–23CrossRef

56.

Pagenstert G, Leumann A, Hintermann B, Valderrabano V (2008) Sports and recreation activity of varus and valgus ankle osteoarthritis before and after realignment surgery. Foot Ankle Int 29(10):985–993PubMedCrossRef

57.

Becker AS, Myerson MS (2009) The indications and technique of supramalleolar osteotomy. Foot Ankle Clin 14(3):549–561PubMedCrossRef

58.

Benthien RA, Myerson MS (2004) Supramalleolar osteotomy for ankle deformity and arthritis. Foot Ankle Clin 9(3):475–487PubMedCrossRef

59.

Cheng YM, Huang PJ, Hong SH, Lin SY, Liao CC, Chiang HC, Chen LC (2001) Low tibial osteotomy for moderate ankle arthritis. Arch Orthop Trauma Surg 121(6):355–358PubMedCrossRef

60.

Harstall R, Lehmann O, Krause F, Weber M (2007) Supramalleolar lateral closing wedge osteotomy for the treatment of varus ankle arthrosis. Foot Ankle Int 28(5):542–548PubMedCrossRef

61.

Hintermann B, Knupp M, Barg A (2008) Osteotomies of the distal tibia and hindfoot for ankle realignment. Orthopade 37(3):212–213PubMedCrossRef

62.

Horn DM, Fragomen AT, Rozbruch SR (2011) Supramalleolar osteotomy using circular external fixation with six-axis deformity correction of the distal tibia. Foot Ankle Int 32(10):986–993PubMedCrossRef

63.

Lee KB, Cho YJ (2009) Oblique supramalleolar opening wedge osteotomy without fibular osteotomy for varus deformity of the ankle. Foot Ankle Int 30(6):565–567PubMedCrossRef

64.

Neumann HW, Lieske S, Schenk K (2007) Supramalleolar, subtractive valgus osteotomy of the tibia in the management of ankle joint degeneration with varus deformity. Oper Orthop Traumatol 19(5–6):511–526PubMedCrossRef

65.

Pagenstert GI, Hintermann B, Barg A, Leumann A, Valderrabano V (2007) Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res 462:156–168PubMedCrossRef

66.

Pagenstert G, Knupp M, Valderrabano V, Hintermann B (2009) Realignment surgery for valgus ankle osteoarthritis. Oper Orthop Traumatol 21(1):77–87PubMedCrossRef

67.

Stamatis ED, Cooper PS, Myerson MS (2003) Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint. Foot Ankle Int 24(10):754–764PubMed

68.

Takakura Y, Tanaka Y, Kumai T, Tamai S (1995) Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg Br 77(1):50–54PubMed

69.

Takakura Y, Takaoka T, Tanaka Y, Yajima H, Tamai S (1998) Results of opening-wedge osteotomy for the treatment of a post-traumatic varus deformity of the ankle. J Bone Joint Surg Am 80(2):213–218PubMed

70.

Lee WC, Moon JS, Lee K, Byun WJ, Lee SH (2011) Indications for supramalleolar osteotomy in patients with ankle osteoarthritis and varus deformity. J Bone Joint Surg Am 93(13):1243–1248PubMedCrossRef

71.

Brunner S, Knupp M, Hintermann B (2010) Total ankle replacement for the valgus unstable osteoarthritic ankle. Tech Foot Ankle 9:165–174CrossRef

72.

Kim BS, Choi WJ, Kim YS, Lee JW (2009) Total ankle replacement in moderate to severe varus deformity of the ankle. J Bone Joint Surg Br 91(9):1183–1190PubMed

73.

Kim BS, Lee JW (2010) Total ankle replacement for the varus unstable osteoarthritic ankle. Tech Foot Ankle 9:157–167CrossRef

74.

Knupp M, Stufkens SA, Bolliger L, Brunner S, Hintermann B (2010) Total ankle replacement and supramalleolar osteotomies for malaligned osteoarthritis ankle. Tech Foot Ankle 9:175–181CrossRef

75.

Wood PL, Deakin S (2003) Total ankle replacement. The results in 200 ankles. J Bone Joint Surg Br 85(3):334–341PubMedCrossRef

76.

Knupp M, Stufkens SA, van Bergen CJ, Blankevoort L, Bolliger L, van Dijk CN, Hintermann B (2011) Effect of supramalleolar varus and valgus deformities on the tibiotalar joint: a cadaveric study. Foot Ankle Int 32(6):609–615PubMedCrossRef

77.

Ting AJ, Tarr RR, Sarmiento A, Wagner K, Resnick C (1987) The role of subtalar motion and ankle contact pressure changes from angular deformities of the tibia. Foot Ankle 7(5):290–299PubMedCrossRef

78.

Tarr RR, Resnick CT, Wagner KS, Sarmiento A (1985) Changes in tibiotalar joint contact areas following experimentally induced tibial angular deformities. Clin Orthop Relat Res 199:72–80PubMed

79.

Wagner KS, Tarr RR, Resnick C, Sarmiento A (1984) The effect of simulated tibial deformities on the ankle joint during the gait cycle. Foot Ankle 5(3):131–141PubMedCrossRef

Title: Supramalleolar osteotomies for degenerative joint disease of the ankle joint: indication, technique and results
Authors: Alexej Barg
Geert I. Pagenstert
Monika Horisberger
Jochen Paul
Marcel Gloyer
Heath B. Henninger
Victor Valderrabano
Publication date: 01-09-2013
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 9/2013
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-013-2030-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Supramalleolar osteotomies for degenerative joint disease of the ankle joint: indication, technique and results

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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