Artikel
Clinical Results and Concepts of Distal Tibial Oblique Osteotomy Joint preservation surgery for Osteoarthritis & Post-trauma of the Ankle Joint
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Autoren
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Nobuyuki Takenaka
- Department of Traumatology FUKUSHIMA Medical University, Southern TOHOKU Research institute for Neuroscience, Koriyama FUKUSHIMA, Japan
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Tsukasa Teramoto
- Department of Traumatology FUKUSHIMA Medical University, Southern TOHOKU research institute for neuroscience, Koriyama Fukushima, Japan
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Narutaka Katoh
- Department of Traumatology FUKUSHIMA Medical University, Southern TOHOKU Research institute for Neuroscience, Koriyama FUKUSHIMA, Japan
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Motoyuki Takaki
- Department of Traumatology FUKUSHIMA Medical University, Southern TOHOKU Research institute for Neuroscience, Koriyama FUKUSHIMA, Japan
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Shota Harada
- Department of Traumatology FUKUSHIMA Medical University, Southern TOHOKU Research institute for Neuroscience, Koriyama FUKUSHIMA, Japan
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Tomohiko Asahara
- Department of Orthopaedic Surgery, Nagasaki Medical Center, Omura,Nagasaki, Japan
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Yoshinobu Watanabe
- Department of Orthopedic surgery Teikyo Univ. School of Med., Tokyo, Japan
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Takashi Matsushita
- Department of Traumatology FUKUSHIMA Medical University, Southern TOHOKU research institute for neuroscience, Koriyama Fukushima, Japan
| Veröffentlicht: | 10. Oktober 2016 |
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Gliederung
Text
Background: Severe ankle osteoarthritis was treated total joint replacement and the ankle fusion. The clinical results of total joint replacement was unstable and the ankle fusion lost all function of the ankle joint. Severe ankle osteoarthritis, for example stage 3 and 4 was treated Distal Tibial Oblique Osteotomy (DTOO).The characteristics of DTOO were preserving the ankle joint and its motion and most of the patients could run again after surgery. The purpose of this study is to report the clinical results and concepts of DTOO.
Methods: The study population comprised 30 patients with the varus-type ankle osteoarthritis and 4 patient with the valgus-type ankle osteoarthritis treated by DTOO. Their age was in the range of 46-80 years, and the average age was 62.1 years. The patients with varus-type osteoarthritis were classified by Tanaka's classification; 3 patient had stage 2 osteoarthritis; 4, stage 3a osteoarthritis; and 15, stage 3b osteoarthritis; 8, stage 4 osteoarthritis. The follow-up period was in the range of 6 months-8 years and the average follow-up period was 4.5 years.
The distal tibia was osteotomized obliquely toward the distal tibiofibular joint under the guidance of an image intensifier and then spread at the osteotomy site by using a spreader. The distal fragment of the tibia must be spread until the lateral articular surface of the talus is in contact with the medial articular surface of the lateral malleolus. Ilizarov External Fixator was used for the fixation of the fragment and the iliac bone was grafted into the spreading space.
The patients were loaded with 2 crutches at 6 or 8 weeks after the surgery. We used a rating scale (JOA) to determine the ankle function both before and after surgery.
Results: The total mean score in the varus-type osteoarthritis group improved from 44.7 to 78.4 points after surgery. The total mean score in the valgus-type osteoarthritis group improved from 44 to 86 points.
Discussion: The purpose of performing DTOO was to increase the contact area of the ankle joint and improve the stability of the ankle joint and the alignment of the foot. The contact area of the ankle joint was regained by the spread of distal tibia and the ankle joint contact totally. Bone instability was caused by the abnormal shapes of the articular surface of the ankle joint This bone instability also improved after DTOO because the distal tibia was spread and the articular surface of the ankle joint became narrow to suit the talus. The alignment of the foot was improved the correction of the distal tibia by spreading.
