[Supramalleolar, subtractive valgus osteotomy of the tibia in the management of ankle joint degeneration with varus deformity].

OBJECTIVE

The aim of supramalleolar osteotomy of the tibia in the management of varus deformity of the upper ankle joint is to shift load bearing away from the severely degenerated medial part of the joint to the lateral part and thus restore physiological alignment of the hindfoot and a plantigrade foot. The intention is to reduce pain and to postpone the need for total endoprosthesis or arthrodesis.

INDICATIONS

Painful degeneration of the ankle joint with varus deformity that has proven resistant to conservative treatment, i.e., > 15 degrees axial malalignment of the tibiotalar joint axis.

CONTRAINDICATIONS

Severe ankle joint degeneration that restricts movement. Florid infections. Extensive bone and soft-tissue defects. Osteonecrosis of the talus with necrotic regions > 50%.

SURGICAL TECHNIQUE

Anterior approach to the upper ankle joint and supramalleolar wedge-shaped resection of a predetermined bone wedge with lateral base. The desired correction is precisely calculated during preoperative planning. Subsequently, lateral approach over the distal fibula. Resection of a more proximal segment from the fibula. Closure of the tibial osteotomy (closed wedge) and osteosynthesis of the fibula.

RESULTS

A supramalleolar valgus osteotomy (closed wedge) was performed in 27 patients from 2002 to 2006. Preoperatively, there was an average varus deformity of 27 degrees , which was corrected to 6 degrees on average postoperatively. 21 patients were very satisfied at follow-up, three patients required joint replacement during the later course, and another three patients needed arthrodesis.