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Low tibial osteotomy (LTO) is an effective joint-preserving surgery for ankle arthritis.
The tibial osteotomy for ankle arthritis ensures acceptable
clinical outcomes. The modified distal tibial oblique osteotomy (DTOO)
procedure is useful for varus ankle arthritis. The researchers of this study
suggested that the modified DTOO procedure can achieve successful tibial union
with minimal postoperative soft-tissue complications and harvesting site
morbidity for patients with ankle osteoarthritis.
Low tibial osteotomy (LTO) is an effective joint-preserving
surgery for ankle arthritis. But, infection, poor postoperative wound healing,
and delayed or non-union of bones remain a significant concern. A modified
distal tibial oblique osteotomy procedure was elucidated and the preliminary
results for varus ankle arthritis were noted.
The osteotomy path consists of an oblique doglegged line
from the lateral end of the distal tibia to a proximal point which is about
one-third from the lateral edge and continues along an arc defined by the
virtual coronal-plane rotation of the doglegged line to the medial edge. After
osteotomy, the distal fragment of tibia was rotated distally in the coronal
plane for the realignment while the contact with the proximal tibia and the
distal tibial fragment was maintained. The resulting wedge-shaped gap was
filled with synthetic bone blocks and tibial bone projecting medially from
rotation. A locking plate was then used for stabilization. 7 ankles from 6
osteoarthritis patients were investigated, both clinically and
radiographically, postoperatively.
Within 3 months after the procedure the bone union was
achieved for all the patients. The Japanese Society for Surgery of the Foot
ankle-hindfoot scale showed improvement from a mean of 38.4 points
preoperatively to 85.7 points at the follow-up. There were no wound healing
problems, infections, or nerve disturbances. Multiple radiographic parameters
were also improved after the operation.
This procedure maintains close bone contact for a better
postoperative union, obviates the need for iliac bone harvesting, and lowers
the tension on the medial soft tissue. These modifications are believd as
potential benefits for achieving stable results in patients with ankle
osteoarthritis.
J Orthop Sci.
Modified distal tibial oblique osteotomy for osteoarthritis of the ankle: Operative procedure and preliminary results
Watanabe K et al.
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