Lower tibial osteotomy for osteoarthritis of the ankle

Ankle arthrodesis is still the treatment of choice for most disabling arthritic ankles. But in spite of its popularity, ankle arthrodesis has many disadvantages, including long immobilization, a high pseudoarthrosis rate, and load shift with increased stress on neighboring joints of ankle. Lower tibial osteotomy is one of the methods which attempts to halt ankle arthritis in the intermediate stage and trying to prevent ankle arthroadesis. From Aug. 1989, we performed 8 operations of lower tibial osteotomy in our hospital on intermediate arthritic ankle which included 4 post-traumatic ankle arthritis and 4 ankle osteoarthritis. The patient's ages ranged from 21y/o to 72y/o with an average of 41.6y/o. The mean time of followed up was 31.7 months. The patients were evaluated by the ankle functional scale preoperatively and during their followed up. The average preoperative functional score was 49.6 and the last follow up score was 88.5 which is increasing year by year. Significant improvement occurred in function and pain relief and there was improvement of ankle motion in most patients except one. Complications included late infection in 1 patient and implant failure with subsequent revision surgery due to overcorrection in 1 patient. No nonunion was noted. Although our series was small, we had encouraging short-term results. We believe lower tibial osteotomy, by pressure redistribution on the joint surface, is an alternative for the treatment of ankle osteoarthritis and may save or delay arthritic ankle from the fate of fusion.