Supramalleolar Osteotomy as a Joint-Preserving Procedure for Varus Ankle Osteoarthritis in Elderly Patients: A Report of Two Cases

Medial opening wedge supramalleolar osteotomy (SMO) is a representative joint-preserving surgical procedure for varus ankle osteoarthritis, based on the principle of load redistribution, with favorable radiologic and clinical outcomes.This procedure is indicated for patients with Takakura stage 2 or 3A arthritis, whereas severe vascular or neurological impairment and osteomyelitis are considered absolute contraindications.Although SMO is generally limited to patients younger than 70 years because of the risk of delayed or nonunion in elderly individuals, few reports on the outcomes in elderly patients have been published.This paper reports two cases of varus ankle osteoarthritis in patients over 75 years of age who underwent SMO after failed conservative treatment, with a follow-up exceeding 2 years, along with a review of the relevant literature.Both cases achieved successful bone union without delayed healing.At the final follow-up, the foot and ankle ability measure (FAAM)-activities of daily living and FAAM-sport scores showed marked improvement compared with the preoperative values.In conclusion, SMO may be a viable joint-preserving treatment option, even in elderly patients, provided that their general health is favorable.