Long-Term Results of Low TibialOsteotomy for Ankle Osteoarthritis

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1 Long-Term Results of Low TibialOsteotomy for Ankle Osteoarthritis Naohiro Hio MD, PhD 1) Atsushi Hasegawa MD, PhD 2) Satoshi Monden MD, PhD 3) Masanori Taki MD, PhD 4) Kazuhiko Tsunoda MD 3) 1) Higashimaebashi Orthopaedic Clinic, Center of Foot and Ankle Surgery 2) Agatsumahigashi Orthopaedic Clinic 3) Kiryu Orthopaedic Hospital 4) Seirei Hamamatsu General Hospital

2 Disclosure NO CONFLICT TO DISCLOSURE < Long-Term Results of Low TibialOsteotomy For Ankle Osteoarthritis > Naohiro Hio Atsushi Hasegawa Satoshi Monden Masanori Taki Kazuhiko Tsunoda Our disclosures are in the Final AOFAS Program Book. We have no potential conflicts with this presentation.

3 There are not many reports about long-term results of low tibialosteotomy (LTO) for ankle osteoarthritis. We report clinical results for cases in which, among the cases where LTO was performed for ankle osteoarthritis caused by malalignment, tracking was possible for 10 years or more.

4 Cases: 11 ankles of 11 patients sex (male / female) 1 / 10 mean age 57y.o. (42 67y.o.) mean follow-up period 11yrs. and 5 mo. (10 17 yrs.) X-ray classification stage ankles varus type stage 2 3 stage 3a 2 stage 3b 5 valgus type 1

5 Operation methods LTO LTO+ medial malleolus osteotomy LTO+ lateral ligament reconstruction LTO + subtalar arthrodesis 3ankles 6ankles 1 ankle 1 ankle

6 Clinical Assessments Takakura s clinical score Radiographic evaluations; X-ray classification, TAS angle, talar tilting angle Our arthroscopic classification; grading by the rate of the eburnation area grade 1 grade 2 grade 3 fibrillation Only the medial talocrural articulation <25% grade 4 grade 5 <50% 50%

7 Takakura sclinical score case pre op. post op. 1 yr. final f/u case case case case case case case case case case case mean 68.7± ± ±12.6 The final follow-up scores were higher than preoperative scores in eight cases.

8 X-ray classification 2 cases stage 4 stage 3b stage 3a stage 2 stage 1 pre op. post op. 1 yr. final f/u pre op. final follow-up TAS angle 83.8± ±7.5 talar tilting angle 9.6± ±3.2 A/S pre op. grade 1 grade 2 grade 3 grade 4 grade 5 A/S grade

9 Spearman's rank correlation coefficient factor Correlation between Takakura s final f/u Correlation between X-ray final f/u X-ray pre op arthroscopic pre op TAS pre op talar tilting pre op TAS final f/u talar tilting final f/u A strongly negative correlativity was seen between preoperative X-ray classification and Takakura s final f/u. A strongly positive correlativity was seen between preoperative X-ray classification, arthroscopic classification and X-ray final f/u.

10 The preoperative talartilt was correlated with the post operative talartilt. The mean AOFAS score was higher and the mean radiographic stage was lower in the group with low postoperative talartilt than in the group with high talartilt. The optional threshold for predicting high postoperative talartilt was 7.3 of preoperative talar tilt. <Lee et al.: JBJS Am 2011> In the long term, the higher X-ray stage and the higher arthroscopic grade are the negative predictors of clinical outcomes in this presentation.

11 pre op. post op. post op. 1 yr. 51 y.o. female pre op. post op. 1 yr. post op. 10 yrs. Takakura s score post op. 10 yrs. In the long term, such as this case, narrowing of the joint space progresses, with clinical results gradually falling, but that progression is gradual, so by performing LTO, it is believed to be possible to maintain functions that adequately tolerate the activities of daily living for that age.

12 References [1] Cheng YM, Huang PJ, Hong SH, Lin SY, Liao CC, et al. (2001) Low tibialosteotomy for moderate ankle arthritis. Arch Orthop Trauma Surg. 121: [2] Hio N, Hasegawa A, Monden S, Noguchi H, TakiM, TakagishiK. (2016) Indications for supramalleolar osteotomy based on arthroscopic findings for varus type ankle osteoarthritis. SM J Orthop 2(1). [3] Lee WC, Moon JS, Lee K, Byun WJ, Lee SH. (2011) Indication for supramalleolar osteotomy in patients with ankle osteoarthritis and varus deformity. J Bone Joint Surg Am. 93: [4] PagenstertGI, HintermannB, BargA, LeumannA, Varderrabano V. (2007) Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res. 462: [5] TakakuraY, Tanaka Y, Sugimoto K, TamaiS, Masuhara K. (1990) Ankle arthroplasty. A comparative study of cemented metal and uncemented ceramic prostheses. Clin Orthop. 252: [6] TakakuraY, Takaoka T, Tanaka Y, YajimaH, TamaiS. (1998) Results of opening-wedge osteotomy for the treatment of a post-traumatic varus deformity of the ankle. J Bone Joint Surg Am. 80: [7] Tanaka Y, TakakuraY, Hayashi K, Taniguchi A, Kumai T, Sugimoto K. (2006) Low tibialosteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg Br. 88: [8] TellisiN, FragomenAT, KleinmanD, O Malley MJ, Rozbruch SR. (2009) Joint preservation of the osteoarthritic ankle using distraction arthroplasty. Foot Ankle Int. 30(4):