Outcomes of spiral osteotomy of the tibia to correct coronal plane deformities in patients with concomitant end-stage osteoarthritis of the ankle

M. Kakwani, J. Coorsh, D. Townshend, R. Kakwani, A. Murty

Introduction: The management of end-stage osteoarthritis of the ankle with concomitant angular deformity of the tibia more than 10 degrees generally necessitates the correction of the deformity prior to operative intervention for the ankle. We present a series of patients with the CORA of tibial deformity at the middle third / lower third junction of the tibia corrected with spiral osteotomy of the tibia. Osteotomies of the tibia around diaphysis have a higher risk of complications including non-union.

Methodology: All patients who underwent the tibial spiral osteotomy and plate fixation under the care of senior authors at our institute between 2008 to 2019 were included in our present study. The patient demographics and details of the operation, degree of correction achieved, complications and any further interventions for the ankle arthritis were noted as well.

Results: A total of 12 patients (M:F = 7:5; average age = 68.8 years) were identified that underwent a spiral tibial osteotomy. Prior to the osteotomy, the average distance from the ankle to the CORA was 10.24 cm and the average degree of coronal plane deformity was 11.24. 10 patients had a varus deformity and 2 patients had a valgus deformity. 4/12 patients went on to have an ankle replacement after the osteotomy, 8/12 had their symptoms well controlled with the osteotomy itself and did not need ankle surgery. None of the patients had non-union or metal-ware failure. 4 patients needed removal of metal-ware.

Conclusion: As a summary, the procedure of spiral oblique tibial osteotomies is a safe and re-producible method to align the tibia prior to definitive interventions for the ankle. 66% of patients had their ankle arthritis symptoms significantly improved by the correction of their limb alignment.