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Supramalleolar osteotomies for ankle arthritis: a systematic review

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

We investigated the mid-term outcomes of supramalleolar osteotomies regarding “survivorship” [before ankle arthrodesis (AA) or total ankle replacement (TAR)], complication rate and adjuvant procedures required.

Material and methods

PubMed, Cochrane and Trip Medical Database were searched from January 01, 2000. Studies reporting on SMOs for ankle arthritis, in minimum of 20 patients aged 17 or older, followed for a minimum of two years, were included. Quality assessment was performed with the Modified Coleman Methodology Score (MCMS). A subgroup analysis of varus/valgus ankles was performed.

Results

Sixteen studies met the inclusion criteria, with 866 SMOs in 851 patients. Mean age of patients was 53.6 (range 17–79) years, and mean follow-up was 49.1 (range 8–168) months. Of the arthritic ankles (646 ankles), 11.1% were classified as Takakura stage I, 24.0% as stage II, 59.9% as stage III and 5.0% as stage IV. The overall MCMS was 55.2 ± 9.6 (fair). Eleven studies (657 SMOs) reported on “survivorship” of SMO, before arthrodesis (2.7%), or total ankle replacement (TAR) (5.8%) was required. Patients required AA after an average of 44.6 (range 7–156) months, and TAR after 36.71 (range 7–152) months. Hardware removal was required in 1.9% and revision in 4.4% of 777 SMOs. Mean AOFAS score was 51.8 preoperatively, improving to 79.1 postoperatively. Mean VAS was 6.5 preoperatively and improved to 2.1 postoperatively. Complications were reported in 5.7% (44 out of 777 SMOs). Soft tissue procedures were performed in 41.0% (310 out of 756 SMOs), whereas concomitant osseous procedures were performed in 59.0% (446 out of 756 SMOs). SMOs performed for valgus ankles failed in 11.1% of patients, vs 5.6% in varus ankles (p < 0.05), with disparity between the different studies.

Conclusions

SMOs combined with adjuvant, osseous and soft tissue, procedures, were performed mostly for arthritic ankles of stage II and III, according to the Takakura classification and offered functional improvement with low complication rate. Approximately, 10% of SMOs failed and patients required AA or TAR, after an average of just over 4 years (50.5 months) after the index surgery. It is debatable whether varus and valgus ankles treated with SMO reveal different success rates.

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Data availability statement

Information and datasets analyzed during the current study available from the corresponding author on reasonable request.

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Acknowledgements

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Authors and Affiliations

  1. Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece

    Panagiotis Christidis, Christos Kalitsis, Theofanis Kantas, Georgios Biniaris & Nikolaos Gougoulias

  2. Department of Trauma and Orthopedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK

    Vasileios Lampridis

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Contributions

PC and NG did the literature search, evaluated the studies included in this review, and did the statistical analysis. All authors contributed to screening articles from the original search agreed on the articles to be included. All authors contributed to the preparation of the manuscript and approved its final content.

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Correspondence to Nikolaos Gougoulias.

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Christidis, P., Lampridis, V., Kalitsis, C. et al. Supramalleolar osteotomies for ankle arthritis: a systematic review. Arch Orthop Trauma Surg 143, 5549–5564 (2023). https://doi.org/10.1007/s00402-023-04867-1

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