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Correction of ankle varus deformity using patient-specific dome-shaped osteotomy guides designed on weight-bearing CT: a pilot study

  • Orthopaedic Surgery
  • Published:
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Abstract

Background

Dome-shaped supramalleolar osteotomies are a well-established treatment option for correcting ankle deformity. However, the procedure remains technically demanding and is limited by a two-dimensional (2D) radiographic planning of a three-dimensional (3D) deformity. Therefore, we implemented a weight-bearing CT (WBCT) to plan a 3D deformity correction using patient-specific guides.

Methods

A 3D-guided dome-shaped supramalleolar osteotomy was performed to correct ankle varus deformity in a case series of five patients with a mean age of 53.8 years (range 47–58). WBCT images were obtained to generate 3D models, which enabled a deformity correction using patient-specific guides. These technical steps are outlined and associated with a retrospective analysis of the clinical outcome using the EFAS score, Foot and Ankle Outcome Score (FAOS) and visual analog pain scale (VAS). Radiographic assessment was performed using the tibial anterior surface angle (TAS), tibiotalar angle (TTS), talar tilt angle (TTA), hindfoot angle (HA), tibial lateral surface angle (TLS) and tibial rotation angle (TRA).

Results

The mean follow-up was 40.8 months (range 8–65) and all patients showed improvements in the EFAS score, FAOS and VAS (p < 0.05). A 3-month postoperative WBCT confirmed healing of the osteotomy site and radiographic improvement of the TAS, TTS and HA (p < 0.05), but the TTA and TRA did not change significantly (p > 0.05).

Conclusion

Dome-shaped supramalleolar osteotomies using 3D-printed guides designed on WBCT are a valuable option in correcting ankle varus deformity and have the potential to mitigate the technical drawbacks of free-hand osteotomies.

Level of evidence

Level 5 case series.

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Author notes

  1. Sebastian Faict and Arne Burssens contributed equally to this work.

Authors and Affiliations

  1. OLV Hospital Aalst-Asse-Ninove, Moorselbaan 164, 9300, Aalst, Belgium

    Sebastian Faict

  2. Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium

    Arne Burssens & Aline Van Oevelen

  3. Department of Orthopaedics, AZ West, Iepersesteenweg 100, 8630, Veurne, Belgium

    Liselore Maeckelbergh

  4. Department of Orthopaedics, ZNA Middelheim, Lindendreef 1, 2020, Antwerpen, Belgium

    Peter Mertens & Kristian Buedts

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Contributions

SF wrote the article and collected data. AB wrote the article and composed the figures. AVO assisted in writing and the computed analysis. LM and PM internally reviewed the article. KB performed the surgery, developed the study design, internally reviewed the article and assisted with data collection and writing.

Corresponding author

Correspondence to Sebastian Faict.

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Conflict of interest

Arne Burssens, MD, reports paid conference costs by Cuvebeam LLC outside the submitted work. Kris Buedts, MD, reports paid consultancies by Stryker and Arthrex outside the submitted work. Sebastian Faict, MD; Aline van Oevelen, MD; Liselore Maeckelbergh, MD; Peter Mertens, MD, declare no conflict of interest.

Ethics

Approval of the local ethical review committee was acquired at the AZ Monica Hospital Antwerp in accordance with the Declaration of Helsinki (Study Number: OG106/01102015).

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All five patients signed the informed consent in their native language.

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The work is not under consideration by any other journal and has not been previously published. The manuscript underwent several revisions with substantial contributions provided by each of the co-authors. The integrity of the work has been guaranteed by each of the co-authors.

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Faict, S., Burssens, A., Van Oevelen, A. et al. Correction of ankle varus deformity using patient-specific dome-shaped osteotomy guides designed on weight-bearing CT: a pilot study. Arch Orthop Trauma Surg 143, 791–799 (2023). https://doi.org/10.1007/s00402-021-04164-9

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