Long-Term Results Of Low Tibial Osteotomy For Ankle Osteoarthritis

Abstract

Category: Ankle Arthritis Introduction/Purpose: There are not many reports about long-term results of low tibial osteotomy (LTO) for ankle osteoarthritis. We mention treatment 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. Methods: The study evaluated 11 ankles of 11 patients. Among these were 1 male and 10 females, with a mean age of 57 years, and a mean observation period of 11 years, 5 months. There were 10 joints of 10 patients with varus type osteoarthritis, and 1 joint of 1 patient with valgus type osteoarthritis. For varus type osteoarthritis, in the Tanaka’s X-ray classification, there were 3 joints at stage 2, 2 joints at stage 3a, and 5 joints at stage 3b. As surgical procedures, LTO was performed for 3 joints, LTO with medial malleolar osteotomy was performed for 6 joints, LTO with reconstruction of collateral ligament was performed for 1 joint, and LTO with subtalar arthrodesis was performed for 1 joint. In the clinical evaluation, we used the score of Takakura et al, and in the postoperative radiographic evaluation, we used Tanaka’s X-ray classification. Results: Clinical results improved from a preoperative mean of 68.7 points to a one-year postoperative score of 77.2 points, with a score at final observation of 76.3 points. The postoperative radiographic evaluation one year after surgery was Stage 1 in 5 joints, and Stage 2 in 5 joints, but at the time of final observation, the results were Stage 1 in 3 joints, Stage 2 in 4 joints, Stage 3a in 1 joint and Stage 4 in 2 joints. The talar tilting angle had improved, from 9.6° preoperatively to 3.9° at the time of final observation. A strongly positive correlativity was seen between preoperative X-ray classification, arthroscopic classification and X- ray classification at the time of final observation. Conclusion: There are no doubt cases where the preoperative severity of the condition has an effect postoperatively, and in the long term, 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.