Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu, Korea.
Department of Orthopedics, Foot and Ankle Division, Hospital for Special Surgery, New York, NY, USA.
Foot Ankle Int. 2022 Feb;43(2):203-210. doi: 10.1177/10711007211036699. Epub 2021 Sep 16.
Late-stage varus ankle arthritis is thought to be associated with varus of the tibial plafond and hindfoot. However, some late-stage varus arthritis show hindfoot valgus, which can be explained by subtalar subluxation with opposite directional motion between the talus and calcaneus. We hypothesized that late-stage varus ankle arthritis with hindfoot valgus could improve with repositional subtalar arthrodesis and supramalleolar osteotomy (SMO). The purpose of this study was to investigate the clinical and radiographic results of the repositional subtalar arthrodesis combined with SMO for late-stage varus ankle arthritis with hindfoot valgus.
This study includes 16 consecutive patients (16 ankles) with late-stage varus ankle arthritis of Takakura stage 3-b and hindfoot valgus who were treated using repositional subtalar arthrodesis combined with SMO and followed for a minimum of 2 years. Clinical results were assessed with the visual analog scale (VAS) and the Foot Function Index (FFI). Radiographic results were assessed with standard parameters measured on weightbearing foot and ankle radiographs. Clinical and radiographic results were evaluated preoperatively and at the last follow-up.
VAS and FFI significantly improved after surgery. Mean talar tilt angle improved from 12.8 ± 2.8 degrees to 3.9 ± 3.1 degrees ( < .001). Talus center migration and Meary angle significantly improved after surgery. Medial distal tibial angle, lateral talocalcaneal angle, hindfoot moment arm, and talonavicular coverage angle significantly changed after surgery. Radiographic stage improved in 15 ankles (93.8%) after surgery.
In this series with minimum 2-year follow-up, we found that late-stage (Takakura stage 3-b) varus ankle arthritis with hindfoot valgus clinically and radiographically improved with repositional subtalar arthrodesis combined with SMO.
Level IV, prognostic.
晚期内翻踝关节炎被认为与距骨平台和后足内翻有关。然而，一些晚期内翻关节炎表现为后足外翻，这可以通过距骨和跟骨之间的反向运动的跗骨下关节半脱位来解释。我们假设晚期内翻踝关节炎伴后足外翻可以通过重新定位的距下关节融合术和距骨上截骨术（SMO）得到改善。本研究旨在探讨晚期内翻踝关节炎伴后足外翻采用重新定位的距下关节融合术联合 SMO 的临床和影像学结果。
本研究纳入了 16 例（16 足）晚期内翻踝关节炎（Takakura 3-b 期）伴后足外翻的连续患者，采用重新定位的距下关节融合术联合 SMO 治疗，随访至少 2 年。采用视觉模拟评分（VAS）和足功能指数（FFI）评估临床结果。采用负重足和踝关节 X 线片上的标准参数评估影像学结果。术前和末次随访时评估临床和影像学结果。
术后 VAS 和 FFI 显著改善。平均距骨倾斜角从 12.8°±2.8°改善至 3.9°±3.1°（<0.001）。术后距骨中心迁移和 Meary 角显著改善。术后内侧胫骨远端角、外侧跟距角、后足力臂和距舟覆盖角显著改变。术后 15 足（93.8%）影像学分期改善。
在这项至少 2 年随访的研究中，我们发现晚期（Takakura 3-b 期）内翻踝关节炎伴后足外翻通过重新定位的距下关节融合术联合 SMO 治疗可获得临床和影像学改善。
IV 级，预后。
