The tibial osteotomy for ankle arthritis ensures acceptable clinical outcomes. The modified distal tibial oblique osteotomy (DTOO) procedure is useful for varus ankle arthritis. The researchers of this study suggested that the modified DTOO procedure can achieve successful tibial union with minimal postoperative soft-tissue complications and harvesting site morbidity for patients with ankle osteoarthritis. 

Low tibial osteotomy (LTO) is an effective joint-preserving surgery for ankle arthritis. But, infection, poor postoperative wound healing, and delayed or non-union of bones remain a significant concern. A modified distal tibial oblique osteotomy procedure was elucidated and the preliminary results for varus ankle arthritis were noted.

The osteotomy path consists of an oblique doglegged line from the lateral end of the distal tibia to a proximal point which is about one-third from the lateral edge and continues along an arc defined by the virtual coronal-plane rotation of the doglegged line to the medial edge. After osteotomy, the distal fragment of tibia was rotated distally in the coronal plane for the realignment while the contact with the proximal tibia and the distal tibial fragment was maintained. The resulting wedge-shaped gap was filled with synthetic bone blocks and tibial bone projecting medially from rotation. A locking plate was then used for stabilization. 7 ankles from 6 osteoarthritis patients were investigated, both clinically and radiographically, postoperatively.

Within 3 months after the procedure the bone union was achieved for all the patients. The Japanese Society for Surgery of the Foot ankle-hindfoot scale showed improvement from a mean of 38.4 points preoperatively to 85.7 points at the follow-up. There were no wound healing problems, infections, or nerve disturbances. Multiple radiographic parameters were also improved after the operation.

This procedure maintains close bone contact for a better postoperative union, obviates the need for iliac bone harvesting, and lowers the tension on the medial soft tissue. These modifications are believd as potential benefits for achieving stable results in patients with ankle osteoarthritis.