Supramalleolar osteotomy combined with fibular osteotomy for mid-stage varus ankle osteoarthritis

Ankle osteoarthritis affects approximately 3% of adults globally, and patients in the middle and late stages often face the risk of joint fusion or replacement. Although simple supranasal osteotomy is an accepted treatment for mid-stage ankle arthritis, its isolated application may alter the biomechanics of the talofibular joint, increase lateral pressure, and lead to postoperative pain; the role of combined fibular osteotomy remains controversial in existing literature. Therefore we performed a retrospective to investigate: 1) the clinical efficacy of the supramalleolar osteotomy (SMOT) combined with fibular osteotomy (FO) in the treatment of varus ankle arthritis, 2) to analyze the impact of this osteotomy procedure on ankle joint deformities through radiographic observations.

SMOT combined with FO could improve the joint function and relieve pain of patients.

This retrospective observational study included 16 patients (6 males and 10 females, aged 56.9 ± 8.2 years old), suffering from mid-stage varus ankle unilateral osteoarthritis (OA). In total 4 patients with traumatic arthritis and 12 patients with primary arthritis. The patients received SMOT combined with FO between February 2021 and March 2022.

The average follow-up time was 19.5 ± 1.9 (range, 16.5-23) months. There were no surgical site infection or non-union after the surgery. American Orthopedic Foot and Ankle Society (AOFAS) score of the patients significantly increased (81.0 ± 6.0 vs. 46.6 ± 9.3 (p < 0.001)) and visual pain score (VAS) significantly decreased (1.1 ± 0.8 vs. 5.1 ± 0.9, P < 0.001) at last follow-up compared to those before treatment. The Tibial Articular Surface angle (88.6 ± 1.7 vs. 82.6 ± 3.1), Talar tilt (1.3 ± 0.7 vs. 6.4 ± 2.7), and Tibial Angle point angle (80.9 ± 3.0 vs. 72.5 ± 3.9) of patients were significantly improved immediately after surgery (all p < 0.001).

Although limited by the retrospective design and lack of control group, this study shows SMOT combined with FO may be an optional therapy strategy for mid-stage varus ankle OA.

IV.