Ankle and Hindfoot Symptoms after Medial Open Wedge High Tibial Osteotomy

Abstract

Medial open wedge high tibial osteotomy (MOWHTO) is a commonly performed procedure for symptomatic medial compartment osteoarthritis (OA). However, little is known about its effects on ipsilateral ankle or hindfoot. The aim of our study was to determine the incidence of ankle or hindfoot problems after MOWHTO and examine its association with radiological indices. Thirty-five knees (32 patients) undergoing navigated MOWHTO were evaluated for the presence of new-onset ankle or hindfoot symptoms after surgery. Pre- and postoperative hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), and tibial plafond inclination (TPI) were measured and compared on standing lower limb alignment radiographs. The mean postoperative change in HKA angle, MPTA, and TPI was 8.8°, 7.0°, and 8.4°, respectively. New-onset unexplained ankle or hindfoot symptoms were seen in 20% of the cases after surgery. Postoperative change in TPI was significantly greater in symptomatic patients as compared with asymptomatic ones (12.8° ± 4.9° vs. 8.1° ± 4.8°, p = 0.03). The odds ratio (OR) for developing ankle or hindfoot symptoms in cases with ≥ 10° change in TPI postoperatively was 10.8 (p = 0.04). Ankle or hindfoot symptoms were successfully managed with conservative treatment in all cases.

Keywords

high tibial osteotomy - open wedge - navigated - tibial plafond inclination - ankle joint line obliquity

• References

• 1 Takenaka T, Ikoma K, Ohashi S. , et al. Hindfoot alignment at one year after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24 (08) 2442-2446
• 2 Norton AA, Callaghan JJ, Amendola A. , et al. Correlation of knee and hindfoot deformities in advanced knee OA: compensatory hindfoot alignment and where it occurs. Clin Orthop Relat Res 2015; 473 (01) 166-174
• 3 Heijens E, Kornherr P, Meister C. The coronal hypomochlion: a tipping point of clinical relevance when planning valgus producing high tibial osteotomies. Bone Joint J 2016; 98-B [phone]
• 4 Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 1979; 10 (03) 585-608
• 5 Choi GW, Yang JH, Park JH. , et al. Changes in coronal alignment of the ankle joint after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 838-845
• 6 Suero EM, Sabbagh Y, Westphal R. , et al. Effect of medial opening wedge high tibial osteotomy on intraarticular knee and ankle contact pressures. J Orthop Res 2015; 33 (04) 598-604
• 7 Lee JH, Jeong BO. Radiologic changes of ankle joint after total knee arthroplasty. Foot Ankle Int 2012; 33 (12) 1087-1092
• 8 Solan MC, Carne A, Davies MS. Gastrocnemius shortening and heel pain. Foot Ankle Clin 2014; 19 (04) 719-738
• 9 Hudes K. Conservative management of a case of tarsal tunnel syndrome. J Can Chiropr Assoc 2010; 54 (02) 100-106
• 10 Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994; 15 (07) 349-353
• 11 Lee KM, Chang CB, Park MS, Kang SB, Kim TK, Chung CY. Changes of knee joint and ankle joint orientations after high tibial osteotomy. Osteoarthritis Cartilage 2015; 23 (02) 232-238
• 12 Kawakami H, Sugano N, Yonenobu K. , et al. Effects of rotation on measurement of lower limb alignment for knee osteotomy. J Orthop Res 2004; 22 (06) 1248-1253