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01-12-2020 | Osteoarthrosis | Research article

Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

Authors: Koji Nozaka, Naohisa Miyakoshi, Takeshi Kashiwagura, Yuji Kasukawa, Hidetomo Saito, Hiroaki Kijima, Shuichi Chida, Hiroyuki Tsuchie, Yoichi Shimada

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

Abstract

Background

In highly active older individuals, end-stage ankle osteoarthritis has traditionally been treated using tibiotalar arthrodesis, which provides considerable pain relief. However, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy is a type of joint preservation surgery that has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator for treating ankle osteoarthritis.

Methods

A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed, followed by angled osteotomy and correction of the distal tibia; the ankle joint was then stabilized after its condition improved. An external fixator was used in all patients, and joint distraction of approximately 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery.

Results

The anteroposterior and lateral mortise angle during weight-bearing, talar tilt angle, and anterior translation of the talus on ankle stress radiography were improved significantly (P < 0.05). Signal changes on magnetic resonance imaging also improved in all patients. Visual analog scale and American Orthopedic Foot & Ankle Society scores improved significantly (P < 0.05), and no severe complications were observed.

Conclusion

DTO with joint distraction may be useful as a joint-preserving surgery for medial ankle osteoarthritis in older patients with high levels of physical activity.

Level of evidence

Level IV, retrospective case series.

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Title: Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis
Authors: Koji Nozaka
Naohisa Miyakoshi
Takeshi Kashiwagura
Yuji Kasukawa
Hidetomo Saito
Hiroaki Kijima
Shuichi Chida
Hiroyuki Tsuchie
Yoichi Shimada
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Osteoarthrosis
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Arthritis
Osteoarthrosis
External Fixator
Published in: BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-020-3061-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

Abstract

Background

Methods

Results

Conclusion

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Level of evidence

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