Distal tibial osteotomy for varus ankle arthritis: A meta-analysis and systematic review

Joint preserving surgical options are essential in modern orthopaedic care. The aim of this study was to review current literature about distal tibial osteotomies for varus osteoarthritis of the ankle joint. A clinical librarian searched electronic from inception to August 2019 using standard terms. Studies that assessed distal tibial osteotomy outcomes (clinical, radiological and complications) in the treatment of varus ankle osteoarthritis with a minimum of one-year follow-up. The search identified 968 studies. Duplicates (225) were removed. On applying inclusion/exclusion criteria to title and abstract review 686 papers were excluded. 57 full-texts were reviewed and a further 45 were excluded. Twelve papers underwent quality assessment and finally only nine included. The nine papers underwent full data extraction and inclusion within the study. Pain scores (VAS) improved in all studies examined. Mean pooled pre-operative VAS was 7.0 and post-operative VAS was 2.5. These results were for 166 ankles. Mean pooled Pre- and post-operative AOFAS scores available for nine studies showed an improvement from 57.7 to 83.6 for 242 ankles. Satisfaction rates were 89.1% from four studies, including 92 ankles. Out of the total number of osteotomies (242) there were four (1.7%) patients who underwent total ankle arthroplasty and five (2.1%) who had arthrodesis at mean follow-up of 45 months (range; 21–99). 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.