title: Supramalleolar Osteotomy With or Without Fibular Osteotomy for Varus Ankle Arthritis.
abstract: BACKGROUND
  Supramalleolar osteotomy (SMOT) is an alternative operative procedure for the management of early and midstage varus ankle arthritis. However, whether fibular osteotomy is needed is controversial. The purpose of the current study was to evaluate the functional and radiologic outcomes of pre- and postoperative SMOT, and to compare the outcomes between patients with and without fibular osteotomy.
  
  
  METHODS
  Forty-one Takakura stage 2 and 3 varus ankle osteoarthritis patients treated with SMOT were included. Fourteen males and 27 females with a mean age of 50.7 (range, 32-71) years were followed with a mean of 36.6 (range, 17-61) months. There were 22 cases with fibular osteotomy and 19 without. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Maryland foot score, and Ankle Osteoarthritis Score (AOS) were used for pre- and postoperative functional evaluation. The tibial articular surface angle (TAS), talar tilt (TT), tibiocrural angle (TC), and tibial lateral surface angle (TLS) were evaluated pre- and postoperatively.
  
  
  RESULTS
  At the last follow-up, the mean AOFAS score (from 50.8 to 83.1 points) and Maryland score (from 58.3 to 81.6 points) in overall were improved (P < .01); the mean AOS pain (from 42.6 to 26.1 points) and function (from 53.4 to 36.8 points) scores were decreased (P < .01). For radiologic evaluation, all the included parameters were improved (P < .05) except TLS. The mean Takakura stage was decreased (P < .01). No significant difference could be detected in comparing the functional outcomes between those with and without fibular osteotomy. However, in the fibular osteotomy group, TT was decreased (P < .05) and TC was improved (P < .01) significantly.
  
  
  CONCLUSIONS
  SMOT was promising, with substantial functional improvement and malalignment correction for varus ankle arthritis. Fibular osteotomy may be necessary in cases with large TT and small TC angles.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Hongmou
authors.affiliation: Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China liangxj33369@163.com.
authors.forename: Liang
authors.initials: L
authors.lastname: Xiaojun
authors.affiliation: Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China.
authors.forename: Li
authors.initials: L
authors.lastname: Yi
authors.affiliation: Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China.
authors.forename: Liu
authors.initials: L
authors.lastname: Hongliang
authors.affiliation: Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China.
authors.forename: Wang
authors.initials: W
authors.lastname: Junhu
authors.affiliation: Foot and Ankle Surgery Department, Honghui Hospital, Xi'an Jiaotong University College of Medicine, China.
authors.forename: Liu
authors.initials: L
authors.lastname: Cheng
mesh_terms: D000842:Ankle / Q000503:physiopathology*; D005360:Fibula / Q000503:physiopathology*; D006801:Humans; D010003:Osteoarthritis / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D010149:Postoperative Pain / Q000145:classification / Q000503:physiopathology*; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*
keywords: ankle arthritis; realignment surgery; supramalleolar osteotomy