Radiographic effects observed in the coronal view after medial malleolar osteotomy at total ankle arthroplasty in rheumatoid arthritis cases |
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| Institution: | 1. Department of Orthopaedics, Osaka University Graduate School of Medicine, Osaka, Japan;2. Department of Rheumatology/Orthopaedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan;3. Department of Orthopaedics, Osaka Rosai Hospital, Osaka, Japan;4. Department of Rheumatology/Orthopaedics, National Hospital Organization, Toneyama Hospital, Osaka, Japan;5. Department of Orthopaedics, Japan Community Health Care Organization (JCHO), Hoshigaoka Medical Center, Osaka, Japan;1. Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey;2. Ankara Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey;1. Department of Orthopedic Surgery, The No.904 Hospital of Peoples Liberation Army, Wuxi 214000, China;2. Wuxi Clinical College of Anhui Medical University, Wuxi, 214000, China;1. Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China;2. National Clinical Research Center for Geriatric Diseases, Beijing, China;1. Tokyo Dental College Ichikawa General Hospital, Department of Orthopaedic Surgery, 5-11-13 Sugano, Ichikawa, Chiba, Japan;2. Shiraishi Spine Clinic, 1-5-1 Marunouchi, Chiyodaku, Tokyo, Japan;3. Murayama Medical Center, Department of Orthopaedic Surgery, 2-37-1 Gakuen, Musashi-Murayama, Tokyo, Japan;4. Saiseikai Yokohamashi Tobu Hospital, Department of Orthopedic Surgery, 3-6-1 Shimosueyosi, Tsurumiku, Yokohama, Kanagawa, Japan;5. Kawasaki Municipal Hospital, Department of Orthopedic Surgery, 12-1 Shinkawadori, Kawasakiku, Kawasaki, Kanagawa, Japan;1. Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan;2. Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan;3. Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan |
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| Abstract: | BackgroundWhen soft tissue balance is not acceptable at total ankle arthroplasty (TAA) for rheumatoid varus deformity, medial malleolar osteotomy has been performed. At the same time, the shape of the ankle joint changes after soft tissue balancing with such an osteotomy, however there is few information for the radiographic findings after the osteotomy. Thus, radiographic changes in the coronal view of such cases were investigated.MethodsJSSF-RA foot and ankle scale and SAFE-Q scores were determined along with pre/postoperative radiographic parameters of the ankle joint in 70 ankles (65 patients) with rheumatoid arthritis followed for a mean of 7.9 years (range, 2–16 years) after TAA. Seven ankles were excluded because those underwent lateral or lateral/medial malleolar osteotomy. Twenty-seven ankles underwent medial malleolar osteotomy, and compared with 36 ankles without osteotomy.ResultsAll ankles achieved bone union after medial malleolar osteotomy, and the tibial medial malleolus (TMM) angle was significantly decreased 30.3°–19.1°] following significant valgus correction TC angle: ?2.7° to 0.5°]. The gap due to medial soft tissue tightness was significantly improved by medial malleolar osteotomy 4.95° to 0.7°]. Lateral malleolar fractures sometimes occurred (19%: 5/27 ankles) at valgus correction, but they healed completely without any internal fixation.ConclusionMedial malleolar osteotomy was useful in rheumatoid varus ankle for not only controlling the soft tissue balance, but also providing a stabilized shape of the ankle joint. Lateral malleolar fractures were caused by valgus correction following medial malleolar osteotomy in some cases, but all fractures were completely healed without any internal fixation. |
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