Hindfoot balancing in total ankle replacement: the role of supramalleolar osteotomies

Purpose

To compare the obtained deformity correction and clinical/functional outcomes between patients who underwent total ankle replacement (TAR) with or without a concurrent supramalleolar osteotomy (SMO) to address a varus and/or recurvatum deformity of the distal tibia.

Methods

Data of 23 patients treated with an additional SMO to correct a varus and/or recurvatum deformity of the distal tibia at the time of TAR were prospectively collected. Twenty-three matched patients who underwent TAR only served as controls.

Results

The American Orthopaedic Foot and Ankle Society (AOFAS)-hindfoot scale and pain assessed on a Visual Analogue Scale (VAS) did not significantly differ between the two groups at the final follow-up (AOFAS-hindfoot scale SMO/TAR group = 82 ± 10; TAR group = 82 ± 12; VAS pain SMO/TAR group = 1 (range, 0–4); TAR group = 1 (range, 0–5)). Ankle range of motion (ROM) did not improve in the SMO/TAR group (pre-operative = 27 ± 13 degrees, last follow-up = 30 ± 9 degrees; P = .294), but did improve in the TAR group (pre-operative = 31 ± 14 degrees, last follow-up = 39 ± 14 degrees; P = .049). Two patients who underwent SMO/TAR showed non-union of the tibial osteotomy, and two patients who underwent TAR only suffered from an intra-operative medial malleolar fracture.

Conclusion

An additional SMO during TAR in patients with a varus and/or recurvatum deformity of the distal tibia is not beneficial in most cases and should only be considered in pronounced multiplanar deformities.