title: Total ankle arthroplasty with combined calcaneal and metatarsal osteotomies for treatment of ankle osteoarthritis with accompanying cavovarus deformities: early results.
abstract: BACKGROUND
  Our study evaluated the short-term clinical and radiographic results of total ankle arthroplasty (TAA) with combined bony reconstructions for treatment of end-stage ankle osteoarthritis with accompanying cavovarus/hindfoot varus deformities.
  
  
  METHODS
  This study included 8 patients (10 ankles) with ankle osteoarthritis (OA) who were treated by TAA with combined calcaneal and metatarsal osteotomies between September 2004 and June 2010 and were followed an average of 17.9 months (12-43 months). Visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, radiographic measurements, and patient satisfaction were evaluated.
  
  
  RESULTS
  The average patient age was 66.2 years (range, 55-76 years). Eighteen bony reconstruction procedures such as lateral sliding calcaneal osteotomy (n = 9) and first metatarsal dorsiflexion osteotomy (n = 4) were performed in addition to TAA. VAS pain score improved from an average of 8.8 (range, 6-10) preoperatively to an average of 2.4 (range, 0-7) (P < .05), and the AOFAS score improved from 36.9 (range, 14-71) preoperatively to 89.3 (range, 68-100) (P < .05). Ninety percent of the patients were satisfied with the results. Radiographically, the tibiocalcaneal angle (TCA) improved from a preoperative average of 19.0 degrees (range, 13-23 degrees) to 0.2 degrees (range, -5.4 to 2.8 degrees), the tibial axis-talar dome angle (TA-TDA) improved from a preoperative average of 15.6 degrees (range, 11.1-18.0 degrees) to 3.3 degrees (range, 1.7-5.6 degrees), and the talar dome-ground surface angle (TD-GSA) improved from a preoperative average of 21.2 degrees (range, 15.4-27.5 degrees) to 5.1 degrees (range, 1.8-10.2 degrees) (P < .05).
  
  
  CONCLUSIONS
  We found that it was occasionally necessary to perform combined calcaneal and metatarsal osteotomies with TAA in order to successfully treat ankle OA with an accompanying cavovarus/varus deformity. The TD-GSA and TCA were also found to be important radiographic parameters in assessing varus ankles.
  
  
  METHODS
  IV, retrospective case series.
authors: Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea. jungfoot@hanmail.net
authors: Hong-Geun
authors: HG
authors: Jung
authors: Seung-Hyub
authors: SH
authors: Jeon
authors: Tae-Hoon
authors: TH
authors: Kim
authors: Jong-Tae
authors: JT
authors: Park
mesh_terms: D000368:Aged; D058737:Arthroplasty, Replacement, Ankle; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005530:Foot Deformities / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D010027:Osteotomy; D010147:Pain Measurement; D017060:Patient Satisfaction; D011859:Radiography