Supramalleolar Osteotomy for Ankle Varus Deformity Alters Subtalar Joint Alignment

Abstract

Background: Although correction of ankle and hindfoot deformity after supramalleolar osteotomy has been investigated extensively, the specific effect on the subtalar joint alignment remains elusive. This can be attributed to the limitations of 2-dimensional measurements, which impede an exact quantification of the 3-dimensional subtalar joint alignment. Therefore, we determined both the ankle, hindfoot, and subtalar joint alignment before and after supramalleolar osteotomy using autogenerated 3-dimensional measurements based on weightbearing CT imaging. Methods: Twenty-nine patients with a mean age of 50.4±10.6 years were retrospectively analyzed in a pre-post study design using weightbearing CT. Inclusion criteria were correction of ankle varus deformity by an opening wedge (n = 22) or dome osteotomy (n = 7). Exclusion criteria consisted of an additional inframalleolar arthrodesis or osteotomy. Corresponding 3-dimensional bone models were reconstructed to compute following autogenerated measurements of the ankle- and hindfoot alignment: tibial anterior surface (TAS), tibiotalar surface (TTS), talar tilt (TT) angle, hindfoot angle (HA). In addition, the talocalcaneal angle (TCA) in the axial (TCAax), sagittal (TCAsag), and coronal (TCAcor) plane were measured to assess the subtalar joint alignment. Results: The preoperative radiographic parameters of the ankle joint alignment (TAS=88±4 degrees, TTS=82±7 degrees, TT=5.8±4.9 degrees) improved significantly relative to their postoperative equivalents (TAS = 93±5 degrees, TTS = 88±7 degrees, TT=4.2±4.5 degrees; P < .05). The following radiographic parameters of the hindfoot and subtalar joint alignment improved significantly from preoperatively (8.7±8.9 degrees, TCAax = 41±10 degrees, TCAsag = 48±10 degrees) to postoperatively (HA=4.5±8.6 degrees, TCAax = 38±9 degrees, TCAsag = 44±11 degrees; P < .05). No significant differences could be detected in the coronal plane alignment of the subtalar joint (TCAcor) pre- compared to postoperatively ( P > .05). Conclusion: This study quantified the 3-dimensional ankle, hindfoot, and subtalar joint alignment after a solitary supramalleolar osteotomy. We found alterations in the subtalar joint alignment, which occurred by 2 to 3 degrees in each anatomic plane. However, before recommendations can be given related to inframalleolar procedures in conjunction to supramalleolar osteotomies, further studies on the variation of subtalar joint alignment change are needed.