Sports and Recreation Activity of Varus and Valgus Ankle Osteoarthritis before and after Realignment Surgery

Abstract

Background: Realignment-surgery to unload ankle osteoarthritis (OA) has been proposed as treatment alternative for varus and valgus ankle OA. Sports activity after this procedure has not been analyzed. Realignment-surgery increases sports activity. Sports activity correlates with ankle pain, function, and alignment, but does not influence revision rate. Materials and Methods: Prospective case series of 35 consecutive patients with post-traumatic varus or valgus ankle OA limited to half tibiotalar joint surface were treated by OA unloading realignment-surgery. Distal tibia osteotomy was used in all cases; additional osteotomies, tendon, ligament procedures in 92% of cases. Main Outcome Measurements: Pain (visual-analogue-scale; VAS), ankle range-of-motion (ROM); function (American-Orthopaedic-Foot-and-Ankle-Society (AOFAS) ankle-score; Swiss-symptom-related-Ankle-Activity-Scale (SAAS); Sports-Frequency-Score (SFS), OA and tibiotalar-alignment-grade (Takakura-Score), and revision surgery. Mean followup was 5 years. Results: Mean values from preoperative to followup: VAS decreased ( p = 0.0001) 4 points; ankle ROM increased ( p = 0.001) 5 degrees; AOFAS-Score increased ( p = 0.0001) 46 points; SAAS increased ( p = 0.0001) 42 points; SFS increased ( p = 0.02) 0.5 grades; Takakura-score decreased ( p = 0.0001) 1.0 grades. Revision surgery was performed in 10 cases (29%). Three of these were revised to ankle arthroplasty. At follow-up, SAAS correlated with VAS, AOFAS score, Takakura score, and not with ROM or SFS. SFS did not correlate with other variables. Patients needing revision surgery had a higher ( p = 0.003) SFS than patients who needed no revision. Conclusion: Realignment-surgery increased sports activity of ankle OA patients. Improved ankle pain and function correlated with ability to perform activity without symptoms; however, sports frequency had no correlation to patients' symptoms but showed higher revision rate. Level of Evidence: II, Prospective Comparative Study