Early effectiveness of a new minimally invasive plate in treatment of varus-type ankle arthritis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Xuewen , LI Heng ,  GONG Xiaofeng , LAI Liangpeng , LI Wenjing , WANG Yan , DU Hui , LI Ying , SUN Ning , WU Yong

Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China;

Corresponding author：

GONG Xiaofeng, Email: gregorygong@sina.com

Keywords：

Varus-type ankle arthritis; new minimally invasive plate; medial open-wedge osteotomy; early effectiveness

DOI：

10.7507/1002-1892.202303099

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Objective To evaluate the early effectiveness of a new minimally invasive plate in the treatment of varus-type ankle arthritis. Methods A clinical data of 15 patients with varus-type ankle arthritis who met the selection criteria between March 2021 and October 2021 were retrospectively analyzed. All the patients were treated with medial open-wedge supramalleolar osteotomy and fibular osteotomy. The osteotomies were fixed with the new minimally invasive plate. There were 7 males and 8 females with an average age of 49.8 years (range, 16-71 years). The causes of ankle arthritis included post-fracture deformity in 1 case, sprain in 8 cases, and acquired clubfoot in 1 case; and 5 cases were without obvious factors. The disease duration ranged from 1 to 12 years, with an average of 4.1 years. Comparisons were made between pre-operation and the last follow-up in the Takakura staging, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, foot function index (FFI), visual analogue scale (VAS) score, tibial anterior surface angle (TAS), tibial lateral surface angle (TLS), and talar tilt (TT). Results All incisions healed by first intention. All patients were followed up 7-18 months (mean, 12.8 months). At last follow-up, the AOFAS ankle-hindfoot score, FFI, VAS score, and Takakura staging significantly improved when compared with the preoperative ones (P<0.05). X-ray films showed that the osteotomy healed at 3 months after operation. At last follow-up, TAS significantly increased and TT decreased when compared with the preoperative ones (P<0.05), and the difference in TLS between pre- and post-operation was not significant (P>0.05). Complications included 1 case of intraoperative screw breakage and 2 cases of nerve injury of the affected foot. None of the patients complained of significant discomfort at the plate placement during follow-up, and no loosening of the internal fixator occurred. Eleven patients were very satisfied with the effeectiveness, while 4 were relatively satisfied. Conclusion The new minimally invasive plate for the varus-type ankle arthritis has good early effectiveness in relieving ankle pain, correcting deformity, improving limb alignment and ankle function, and reducing the incidence of postoperative incisional complications.

Citation： WANG Xuewen, LI Heng, GONG Xiaofeng, LAI Liangpeng, LI Wenjing, WANG Yan, DU Hui, LI Ying, SUN Ning, WU Yong. Early effectiveness of a new minimally invasive plate in treatment of varus-type ankle arthritis. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(7): 776-781. doi: 10.7507/1002-1892.202303099 Copy

1.	Al-Nammari SS, Myerson MS. The use of tibial osteotomy (ankle plafondplasty) for joint preservation of ankle deformity and early arthritis. Foot Ankle Clin, 2016, 21(1): 15-26.
2.	Nwankwo EC, Labaran LA, Athas V, et al. Pathogenesis of Posttraumatic Osteoarthritis of the Ankle. Orthop Clin North Am, 2019, 50(4): 529-537.
3.	Honkamp N, Amendola A, Hurwitz S, et al. Retrospective review of eighteen patients who underwent transtibial amputation for intractable pain. J Bone Joint Surg (Am), 2001, 83(10): 1479-1483.
4.	Zvijac JE, Lemak L, Schurhoff MR, et al. Analysis of arthroscopically assisted ankle arthrodesis. Arthroscopy, 2002, 18(1): 70-75.
5.	Wang B, Saltzman CL, Chalayon O, et al. Does the subtalar joint compensate for ankle malalignment in end-stage ankle arthritis? Clin Orthop Relat Res, 2015, 473(1): 318-325.
6.	Tanaka Y. The concept of ankle joint preserving surgery: why does supramalleolar osteotomy work and how to decide when to do an osteotomy or joint replacement. Foot Ankle Clin, 2012, 17(4): 545-553.
7.	Tanaka Y, Takakura Y, Hayashi K, et al. Low tibial osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg (Br), 2006, 88(7): 909-913.
8.	北京积水潭医院, 北京科仪邦恩医疗器械科技有限公司. 一种接骨板及其加固楔块: CN216021328U[P]. 2022-03-15.
9.	Hintermann B, Ruiz R, Barg A. Novel double osteotomy technique of distal tibia for correction of asymmetric varus osteoarthritic ankle. Foot Ankle Int, 2017, 38(9): 970-981.
10.	Barg A, Pagenstert G, Leumann A, et al. Malleolar osteotomy-osteotomy as approach. Orthopade, 2013, 42(5): 309-321.
11.	Horisberger M, Hintermann B, Valderrabano V. Alterations of plantar pressure distribution in posttraumatic end-stage ankle osteoarthritis. Clin Biomech (Bristol, Avon), 2009, 24(3): 303-307.
12.	Knupp M, Stufkens SA, Bolliger L, et al. Classification and treatment of supramalleolar deformities. Foot Ankle Int, 2011, 32(11): 1023-1031.
13.	Takakura Y, Tanaka Y, Kumai T, et al. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg (Br), 1995, 77(1): 50-54.
14.	Takakura Y, Takaoka T, Tanaka Y, et al. Results of opening-wedge osteotomy for the treatment of a post-traumatic varus deformity of the ankle. J Bone Joint Surg (Am), 1998, 80(2): 213-218.
15.	Hintermann B, Knupp M, Barg A. Supramalleolar osteotomies for the treatment of ankle arthritis. J Am Acad Orthop Surg, 2016, 24(7): 424-432.
16.	Chopra V, Stone P, Ng A. Supramalleolar osteotomies. Clin Podiatr Med Surg, 2017, 34(4): 445-460.
17.	Knupp M, Barg A, Bolliger L, et al. Reconstructive surgery for overcorrected clubfoot in adults. J Bone Joint Surg (Am), 2012, 94(15): e1101-e1107.
18.	Barg A, Saltzman CL. Single-stage supramalleolar osteotomy for coronal plane deformity. Curr Rev Musculoskelet Med, 2014, 7(4): 277-291.

1. Al-Nammari SS, Myerson MS. The use of tibial osteotomy (ankle plafondplasty) for joint preservation of ankle deformity and early arthritis. Foot Ankle Clin, 2016, 21(1): 15-26.
2. Nwankwo EC, Labaran LA, Athas V, et al. Pathogenesis of Posttraumatic Osteoarthritis of the Ankle. Orthop Clin North Am, 2019, 50(4): 529-537.
3. Honkamp N, Amendola A, Hurwitz S, et al. Retrospective review of eighteen patients who underwent transtibial amputation for intractable pain. J Bone Joint Surg (Am), 2001, 83(10): 1479-1483.
4. Zvijac JE, Lemak L, Schurhoff MR, et al. Analysis of arthroscopically assisted ankle arthrodesis. Arthroscopy, 2002, 18(1): 70-75.
5. Wang B, Saltzman CL, Chalayon O, et al. Does the subtalar joint compensate for ankle malalignment in end-stage ankle arthritis? Clin Orthop Relat Res, 2015, 473(1): 318-325.
6. Tanaka Y. The concept of ankle joint preserving surgery: why does supramalleolar osteotomy work and how to decide when to do an osteotomy or joint replacement. Foot Ankle Clin, 2012, 17(4): 545-553.
7. Tanaka Y, Takakura Y, Hayashi K, et al. Low tibial osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg (Br), 2006, 88(7): 909-913.
8. 北京积水潭医院, 北京科仪邦恩医疗器械科技有限公司. 一种接骨板及其加固楔块: CN216021328U[P]. 2022-03-15.
9. Hintermann B, Ruiz R, Barg A. Novel double osteotomy technique of distal tibia for correction of asymmetric varus osteoarthritic ankle. Foot Ankle Int, 2017, 38(9): 970-981.
10. Barg A, Pagenstert G, Leumann A, et al. Malleolar osteotomy-osteotomy as approach. Orthopade, 2013, 42(5): 309-321.
11. Horisberger M, Hintermann B, Valderrabano V. Alterations of plantar pressure distribution in posttraumatic end-stage ankle osteoarthritis. Clin Biomech (Bristol, Avon), 2009, 24(3): 303-307.
12. Knupp M, Stufkens SA, Bolliger L, et al. Classification and treatment of supramalleolar deformities. Foot Ankle Int, 2011, 32(11): 1023-1031.
13. Takakura Y, Tanaka Y, Kumai T, et al. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg (Br), 1995, 77(1): 50-54.
14. Takakura Y, Takaoka T, Tanaka Y, et al. Results of opening-wedge osteotomy for the treatment of a post-traumatic varus deformity of the ankle. J Bone Joint Surg (Am), 1998, 80(2): 213-218.
15. Hintermann B, Knupp M, Barg A. Supramalleolar osteotomies for the treatment of ankle arthritis. J Am Acad Orthop Surg, 2016, 24(7): 424-432.
16. Chopra V, Stone P, Ng A. Supramalleolar osteotomies. Clin Podiatr Med Surg, 2017, 34(4): 445-460.
17. Knupp M, Barg A, Bolliger L, et al. Reconstructive surgery for overcorrected clubfoot in adults. J Bone Joint Surg (Am), 2012, 94(15): e1101-e1107.
18. Barg A, Saltzman CL. Single-stage supramalleolar osteotomy for coronal plane deformity. Curr Rev Musculoskelet Med, 2014, 7(4): 277-291.

Chinese Journal of Reparative and Reconstructive Surgery

Early effectiveness of a new minimally invasive plate in treatment of varus-type ankle arthritis

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