Static posture weightbearing joint angle differences in patients with varus ankle osteoarthritis

BACKGROUND

Advanced varus ankle osteoarthritis is a debilitating disease that can present with limited physical function, severe pain, and diminished quality of life. Weightbearing computed tomography enables submillimeter 3-dimensional visualization, computational analyses, and enhanced diagnoses in reporting complex degenerative changes more accurately.

RESEARCH QUESTION

This study set to compare static posture weightbearing joint angle differences in healthy and varus ankle osteoarthritis patients (compensated and non-compensated).

METHODS

Our retrospective assessment included 70 individuals, 44 of whom were diagnosed with advanced varus ankle osteoarthritis, and the remaining 26 were healthy participants to serve as controls. An automatic anatomic coordinate system was applied to each patient's 3-dimensional talus and calcaneus bone reconstructions from weightbearing computed tomography scans. Subtalar and midtarsal joint angles were calculated using Euler angles.

RESULTS

We report statistical differences between the healthy group and both advanced varus osteoarthritis groups for midtarsal inversion/eversion. Specifically, both osteoarthritis groups' midtarsal joints were more inverted and plantarflexed as compared to healthy participants. Compensated and non-compensated subtalar joints were statistically different with respect to inversion/eversion. Non-compensated ankles exhibited a similar mean to healthy ankles who were both less inverted than compensated ankles.

SIGNIFICANCE

Our study helps physicians to better understand underlying mechanisms of peritalar compensation in varus ankle osteoarthritis. Patients featuring hindfoot compensation on average had a greater subtalar joint angle indicating greater inversion than healthy and non-compensated patients.

Spontaneous Resolution of Pediatric Varus Ankle Deformity: A Case Report

Introduction

Distal tibia fractures are a common cause of physeal injuries that can subsequently cause deformity in pediatric populations. Limited literature exists supporting treatment strategies for varus deformities. In this study, we illustrate a unique case of premature physeal closure complicated by development of a varus ankle deformity treated with navigation guided physeal bar resection that spontaneously resolved without the requirement for guided growth.

Case Report

A 6-year-old female presented to our clinic after development of a right ankle varus deformity measuring 14°. She had sustained a right Salter Harris type 3 distal tibia fracture 10 months prior and underwent fixation at an external facility. After undergoing navigation guided physeal bar resection, resolution of her deformity occurred without the use of guided growth.

Conclusion

Spontaneous resolution of an ankle deformity is possible after a physeal bar resection. However, in these technically demanding procedures, it is important to optimize accuracy and results using preoperative bar mapping and intraoperative three-dimensional navigation.

Tibiotalocalcaneal and Tibiotalar Arthrodesis for Severe Cavovarus Deformity: Tips and Tricks

Cavovarus foot is a complex 3-dimensional deformity. Clinical history, physical examination, and comorbidity assessment are essential for preoperative evaluation. In severe cases, ankle or tibiotalocalcaneal arthrodesis can provide symptomatic relief and result in a plantigrade foot. This article emphasizes the importance of weight-bearing computed tomography for surgical planning and presents the authors' preferred technique for tibiotalocalcaneal, which includes a novel curved anterolateral incision, partial fibular onlay bridging graft, and patient-specific instrumentation for forefoot deformity correction. The tips and tricks aim to assist surgeons in better treating these challenging patients while optimizing preoperative planning.

The Role of Supramalleolar Osteotomies in Ankle Arthritis

The supramalleolar osteotomy (SMO) is a joint-preserving surgical procedure that allows realignment of the ankle joint in severe deformity secondary to arthritis. This osteotomy realigns the mechanical axis to provide better weight distribution through the ankle joint. With an aligned mechanical axis, the overloaded asymmetric ankle joint will shift toward the preserved joint area in a valgus or varus ankle joint. The SMO also can be used via a staged approach to correct severe deformity in an end-stage arthritic ankle before total ankle arthroplasty to optimize the implant's longevity and improve overall functional outcomes.

Current Techniques in Total Ankle Arthroplasty

Total ankle replacement (TAR) continues to increase in popularity as a motion-preserving option to ankle arthrodesis. TAR is indicated for primary, posttraumatic and inflammatory arthropathies as an alternative procedure to tibiotalar arthrodesis. Proper patient selection is paramount to a successful outcome in TAR. Contraindications to TAR include the presence of neuropathy, active infection, severe peripheral arterial disease, inadequate bone stock, and severe uncorrectable coronal plane deformity. This article is a brief overview of techniques and PEARLS on how to address a well-aligned ankle joint, varus deformity as well as valgus deformities as well as the authors' experience with single versus staging coronal plane deformities.

Joint Preservation Strategies for Managing Varus Ankle Deformities

Joint preserving strategies have evolved to a successful treatment option in early and midstage medial ankle OA caused by varus deformity. Though talar tilt can often not be fully corrected, it provides substantial postoperative pain relief, functional improvement, and slowing of the degenerative process. Osseous balancing with osteotomies is the main step for restoration of ankle mechanics and normalization of joint load. Overall, the key for success is to understand the underlying causes that have contributed to the varus OA in each case, and to use all treatment modalities necessary to restore appropriate alignment of the hindfoot complex.

Arthrodesis of a Varus Ankle

Patients with varus ankle deformity and concomitant osteoarthritis experience severe disabling pain that affects their daily activity of living. Most cases rarely respond to nonoperative treatment. One surgical option is corrective ankle arthrodesis. Unfortunately, this corrective surgery is challenging and might not be possible as a purely isolated procedure. Corrective ankle arthrodesis for varus ankle is performed with different surgical approaches and techniques, using different methods of fixations. The goal of surgery is to create a pain-free, stable, and plantigrade ankle, hindfoot, and foot. Both the foot and ankle must be correctly aligned in the optimal position for proper locomotion.

Recent Advances in Foot and Ankle Surgery in Mainland China: Correction of Severe Foot and Ankle Deformities

Foot and ankle physicians in China encounter quite a large amount of severe and complex deformities. The main cause of severe ankle and foot deformity is trauma, while the other causes may be neuromuscular diseases, improper reduction and fixation and so on. Staged procedure may sometimes be a safer way to correct deformities in the presence of severe soft tissue contracture. Periarticular osteotomy combined with soft tissue balancing can be used in treating severe varus ankle arthritis, including stage IIIb cases and patients with talar tilt of more than 10 degrees.

The Use of Tibial Osteotomy (Ankle Plafondplasty) for Joint Preservation of Ankle Deformity and Early Arthritis

Asymmetric ankle osteoarthritis (OA) is an increasingly recognized condition. It is imperative to differentiate between extraarticular and intraarticular deformity and to address these appropriately. Any associated instability and multilevel deformity must be recognized and addressed. Patients with intraarticular varus or valgus asymmetric OA have poorer outcomes and higher rates of recurrence when treated with standard techniques targeted at correction with traditional supramalleolar or inframalleolar techniques. Plafondplasty aims to correct the deformity at its center of rotation and angulation and is associated with low rates of recurrence, substantial postoperative pain relief, functional improvement, and a possible slowing of the degenerative process.

Supramalleolar Osteotomy: Indications and Surgical Techniques

Supramalleolar osteotomies are a surgical treatment option for asymmetric varus or valgus ankle arthritis where at least 50% of the joint surface is spared. Procedure selection requires significant preoperative planning for appropriate execution. Thus, the surgeon must be familiar with the principles of deformity correction. With appropriate patient selection and proper preoperative planning, the procedure has been shown to yield excellent results, redistributing forces more evenly across the ankle joint by restoring the mechanical axis of the lower leg with minimal complications.

Lateral ankle and hindfoot instability: a new clinical based classification

Ankle sprains are one of the most common soft tissue injuries accounting for nearly 40% of sports injuries. There are large number of procedures for its treatment reported in the literature with largely good results. The ankle forms a functional unit with the subtalar joint. We present a new classification for peritalar lateral instability. There are two intents of this classification. Firstly, the classification demonstrates an assessment and treatment guideline for the many causes of peritalar lateral instability. The second use of the classification is for research purposes so that cohorts of patients can be accurately described and the efficacy of different operations in different groups can be properly assessed.

Joint-preserving surgery of asymmetric ankle osteoarthritis with peritalar instability

A varus or valgus talar tilt that increases under weight-bearing is commonly seen in osteoarthritic ankles. Loss of peritalar stability may be the underlying cause for the talus shifting and rotating on the calcaneonavicular surfaces, as given by applied forces. The instability pattern and the resulting deformity can be assessed and classified using weight-bearing conventional radiographs. Appropriate osseous balancing may be the most appropriate treatment to restore a regular position of talus within the ankle mortise. In cases with severe peritalar instability, subtalar fusion may be advised. Soft tissue reconstruction may be needed to achieve physiologic balance of the hindfoot complex.