Ankle Osteotomy
Ankle osteotomy surgery is a specialised technique used to treat ankle arthritis associated with a tilted joint, in younger patients. It works by realigning the ankle, which distributes the joint forces towards areas of normal cartilage.
Why have the surgery?
Ankle arthritis is a debilitating condition characterised by pain. If the ankle joint is also tilted, the arthritis is confined to one part of the joint, and the patient is young, an osteotomy may be the solution. Osteotomy means cutting and moving a bone, and this could either be done above or below the ankle joint depending upon the anatomy. It preserves the native ankle and thus preserves the existing movement of the joint whilst simultaneously improve pain.
How is surgery performed?
The operation is typically performed under a general anaesthetic. It is common to combine the procedure with an arthroscopy (key-hole surgery) of the ankle to tidy up the ankle joint, and potentially a repair of ligaments if they are loose. Most osteotomies are made on the shin bone (tibia) which is known as a supramalleolar osteotomy. An incision is made on the side of the ankle and tibia is cut, reorientated and stabilised with a metal plate.
What are the benefits?
The operation carries a high chance of resolving ankle pain in the appropriately selected patient. By improving pain, often function such as standing and walking will become easier.
What are the risks?
All operations have risks, but the commonest and most concerning for this surgery are: - Ongoing pain due to progression of the arthritis - Fracture of the construct meaning that the plate is not strong enough to hold the bones in their new position. - Blood clots in the legs, which can travel to the lungs. Blood thinning tablets or injections can be given to reduce this risk. This list is not exhaustive and Mr Patel can talk you through them all in more detail during a consultation.
What recovery is involved?
All surgeons have different protocols after surgery. Mr Patel typically keeps a patient in a plaster cast for six weeks to allow the bone to heal with full weight-bearing allowed from six weeks. A pneumatic walking boot is then used for up to four weeks as a bridge to normal footwear.
Any other considerations?
Ankle osteotomy surgery is only appropriate in a small subset of patients with ankle arthritis. It has the advantage of being joint preserving, and can offer similar outcomes to replacement and fusion surgery when correctly indicated and performed.