Total Ankle Arthroplasty With Combined Calcaneal and Metatarsal Osteotomies for Treatment of Ankle Osteoarthritis With Accompanying Cavovarus Deformities

Abstract

Background: Our study evaluated the short-term clinical and radiographic results of total ankle arthroplasty (TAA) with combined bony reconstructions for treatment of end-stage ankle osteoarthritis with accompanying cavovarus/hindfoot varus deformities. Methods: This study included 8 patients (10 ankles) with ankle osteoarthritis (OA) who were treated by TAA with combined calcaneal and metatarsal osteotomies between September 2004 and June 2010 and were followed an average of 17.9 months (12-43 months). Visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, radiographic measurements, and patient satisfaction were evaluated. Results: The average patient age was 66.2 years (range, 55-76 years). Eighteen bony reconstruction procedures such as lateral sliding calcaneal osteotomy (n = 9) and first metatarsal dorsiflexion osteotomy (n = 4) were performed in addition to TAA. VAS pain score improved from an average of 8.8 (range, 6-10) preoperatively to an average of 2.4 (range, 0-7) ( P < .05), and the AOFAS score improved from 36.9 (range, 14-71) preoperatively to 89.3 (range, 68-100) ( P < .05). Ninety percent of the patients were satisfied with the results. Radiographically, the tibiocalcaneal angle (TCA) improved from a preoperative average of 19.0 degrees (range, 13-23 degrees) to 0.2 degrees (range, –5.4 to 2.8 degrees), the tibial axis–talar dome angle (TA-TDA) improved from a preoperative average of 15.6 degrees (range, 11.1-18.0 degrees) to 3.3 degrees (range, 1.7-5.6 degrees), and the talar dome–ground surface angle (TD-GSA) improved from a preoperative average of 21.2 degrees (range, 15.4-27.5 degrees) to 5.1 degrees (range, 1.8-10.2 degrees) ( P < .05). Conclusion: We found that it was occasionally necessary to perform combined calcaneal and metatarsal osteotomies with TAA in order to successfully treat ankle OA with an accompanying cavovarus/varus deformity. The TD-GSA and TCA were also found to be important radiographic parameters in assessing varus ankles. Level of Evidence: IV, retrospective case series.