Hindfoot balancing in total ankle replacement: the role of supramalleolar osteotomies
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ORIGINAL PAPER
Hindfoot balancing in total ankle replacement: the role of supramalleolar osteotomies Anne-Constance Franz 1 & Nicola Krähenbühl 1 Beat Hintermann 1
&
Roxa Ruiz 1 & Roman Susdorf 1 & Tamara Horn-Lang 1 & Alexej Barg 2,3 &
Received: 8 April 2020 / Accepted: 22 June 2020 # SICOT aisbl 2020
Abstract Purpose To compare the obtained deformity correction and clinical/functional outcomes between patients who underwent total ankle replacement (TAR) with or without a concurrent supramalleolar osteotomy (SMO) to address a varus and/or recurvatum deformity of the distal tibia. Methods Data of 23 patients treated with an additional SMO to correct a varus and/or recurvatum deformity of the distal tibia at the time of TAR were prospectively collected. Twenty-three matched patients who underwent TAR only served as controls. Results The American Orthopaedic Foot and Ankle Society (AOFAS)-hindfoot scale and pain assessed on a Visual Analogue Scale (VAS) did not significantly differ between the two groups at the final follow-up (AOFAS-hindfoot scale SMO/TAR group = 82 ± 10; TAR group = 82 ± 12; VAS pain SMO/TAR group = 1 (range, 0–4); TAR group = 1 (range, 0–5)). Ankle range of motion (ROM) did not improve in the SMO/TAR group (pre-operative = 27 ± 13 degrees, last follow-up = 30 ± 9 degrees; P = .294), but did improve in the TAR group (pre-operative = 31 ± 14 degrees, last follow-up = 39 ± 14 degrees; P = .049). Two patients who underwent SMO/TAR showed non-union of the tibial osteotomy, and two patients who underwent TAR only suffered from an intra-operative medial malleolar fracture. Conclusion An additional SMO during TAR in patients with a varus and/or recurvatum deformity of the distal tibia is not beneficial in most cases and should only be considered in pronounced multiplanar deformities. Keywords Total ankle replacement . Realignment surgery . Ankle osteoarthritis . Varus deformity
Introduction In the last two decades, total ankle replacement (TAR) has become a well-accepted treatment option for end-stage ankle osteoarthritis [1–7]. Recent studies highlighted the impact of appropriate balancing of the ankle joint on radiographic and clinical outcomes following TAR [8–10]. In case of Level of evidence: III, case-control study * Nicola Krähenbühl [email protected] 1
Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
2
Department of Trauma- and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
3
Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
malalignment of the prosthesis components, periarticular soft tissue structures can be overused, leading to pain and gait impairment [8–10]. To avoid inferior outcomes and early failure after TAR, hindfoot deformities should be properly addressed during prosthesis implantation [8–12]. The role of an additional supramalleolar osteotomy (SMO) to realign deformities at the level of the distal tibia during TAR
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