Mid-term outcomes of distal tibial oblique osteotomy for rheumatoid arthritis-associated ankle arthropathy: A comparison with osteoarthritis outcomes.

Background: Distal tibial oblique osteotomy (DTOO) has traditionally been contraindicated in 'patients with rheumatoid arthritis (RA)'. However, with advances in RA treatment, an increasing number of patients present with arthritis resembling osteoarthritis (OA), suggesting DTOO as a potential option. This study aimed to compare mid-term clinical and radiographic outcomes of DTOO between the patients with OA and RA.

Methods: This study included eight ankles of seven patients with OA (Stage IIIa-IIIb, Takakura-Tanaka classification) and five ankles of five patients with RA (equivalent to Stage IIIa). Clinical outcomes [Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale, Self-Administered Foot Evaluation Questionnaire (SAFE-Q)], radiographic parameters, ankle range of motion (ROM), and complications were assessed preoperatively and at the final follow-up.

Results: Postoperative JSSF and SAFE-Q scores improved significantly in both groups, without intergroup differences. Radiographic parameters showed no significant differences preoperatively or postoperatively, with consistent trends across groups. The patients with OA demonstrated significant postoperative ROM improvement, whereas the patients with RA maintained preoperative ROM. Complications included plate removal in one OA case due to discomfort and two RA cases due to infection.

Conclusions: DTOO provides good outcomes in the patients with RA with controlled disease activity, suggesting it as a viable joint-preserving surgical option for the selected patients with RA.