Supramalleolar Osteotomy for Tibial Component Malposition in Total Ankle Replacement

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Reconstruction
• Arthroplasty Revision Strategies

Background:

• Persistent pain after total ankle replacement (TAR) is common, often due to malaligned components.
• Corrective supramalleolar osteotomy offers an alternative to revision surgery by addressing tibial malalignment above the implant.
• This extraarticular technique preserves the integrity of the existing total ankle arthroplasty.

Purpose of the Study:

• To evaluate the efficacy of corrective supramalleolar osteotomy in realigning varus-misaligned tibial components in total ankle replacement.
• To assess the impact of this procedure on pain relief and functional improvement in patients with painful TAR.
• To hypothesize that supramalleolar osteotomy corrects malpositioned components, leading to better patient outcomes.

Main Methods:

• A case series of 22 patients (mean age 62.6 years) undergoing supramalleolar osteotomy for painful, varus-misaligned TAR tibial components.
• Prospective collection and analysis of radiologic and clinical outcome data, including complications and reoperations.
• Level IV evidence based on a case series study design.

Main Results:

• Significant improvement in tibial alignment (tibial anterior surface angle increased from 85.2° to 91.4°, P < .0001).
• Significant reduction in pain (Visual Analog Scale decreased from 5.8 to 3.3, P < .001) and improvement in function (American Orthopaedic Foot & Ankle Society hindfoot score increased from 46 to 66, P < .0001).
• High patient satisfaction (68% very satisfied), with osteotomy healing in most cases, though nonunion occurred in 14%.

Conclusions:

• Supramalleolar osteotomy is a reliable method for correcting varus malalignment of the tibial component in painful total ankle replacements.
• While nonunion is a complication (14%), the extraarticular approach avoids compromising the replaced ankle's function.
• This procedure effectively relieves pain and improves function without necessitating revision of a well-fixed ankle arthroplasty.