Distal tibial osteotomy for varus ankle arthritis: a systematic review
ESSKA Academy. Aujla R. Nov 8, 2019; 286364
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Distal tibial osteotomy for varus ankle arthritis: a systematic review

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Topic: Hindfoot Arthritis

Aujla R., Siddiqui B., Perianayagam G., Divall P., Bhatia M.
University Hospitals of Leicester, Leicester, United Kingdom

Joint preservation is a key facet in the management of joint arthritis. However, osteotomy for ankle arthritis remains a less frequent option undertaken despite the limitations in arthrodesis and arthroplasty of the ankle. The aim of this systematic review was to aggregate current literature about distal tibial osteotomies for varus osteoarthritis.
A clinical librarian searched electronic databases Medline, Ovid EMBASE, CINAHL and Cochrane CENTRAL from inception to October 2018 using standard terms. Inclusion criteria were studies that assessed distal tibial osteotomy outcomes (clinical, radiological and complications) in the treatment of varus ankle arthritis with a minimum of one-year follow-up.
The search identified 698 studies. Following title and abstract review 645 papers were excluded when applying inclusion/exclusion criteria. 53 full-texts were reviewed and a further 41 were excluded. 12 papers underwent quality assessment. Three studies failed this quality assessment and were excluded. Finally nine papers underwent full data extraction and inclusion within the study. Pain scores (VAS) improved in all studies examined. Visual analogue scores (VAS) from 0-10 were used. Mean pooled pre-operative VAS was 7.1 and improved to 2.3 in 131 ankles. AOFAS improved from 59.1 to 84.9 for 166 ankles. Satisfaction rates were 88.1% from five studies, including 109 ankles. Out of the total number of osteotomies (192) there were three (1.6%) patients who underwent total ankle arthroplasty and four (2.1%) who had arthrodesis at mean follow-up of 45 months (range; 21-99). There were eight (4.2%) non-unions required further revision surgery.
Distal tibial osteotomy can provide significant pain relief and improvement in functional scores. Satisfaction is high with a low level of complications. It is a viable option for joint preservation in carefully selected patients.
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