Calcaneocuboid Distraction Arthrodesis With Synthetic Bone Grafts: Preliminary Results of an Innovative Bone Grafting Procedure in 13 Patients

Abstract

Calcaneocuboid distraction arthrodesis (CCDA) is regarded as an effective method for reconstructing adult-acquired flatfoot deformity. In the present study, we present our experience with newly developed rigid β-tricalcium phosphate wedges to treat CCDA to better understand the outcomes of this synthetic bone grafting procedure. A total of 13 feet in 13 patients underwent CCDA with synthetic bone grafts. One male (7.69%) and 12 females (92.31%), with a mean age of 65.07 ± 11.83 (range 36 to 77) years, were followed up for a mean duration of 32.76 ± 12.81 (range 18 to 55) months. Successful graft union was postoperatively obtained in 12 of the 13 feet (92.31%). The mean preoperative visual analog scale and American Orthopaedic Foot and Ankle Society scale score were 7.97 ± 1.52 (range 5.4 to 10) and 54.46 ± 14.72 (range 18 to 75), respectively. These scores improved to 1.52 ± 1.78 (range 0 to 6.2) and 85.46 ± 13.38 (range 50 to 97) postoperatively (p = .001 for both comparisons). On radiographic analysis, the talonavicular coverage angle, first metatarsal talar angle, calcaneal pitch, and heel alignment angle had significantly improved (p = .001, p = .028, p = .006, and p = .001, respectively). The use of bone graft substitutes in CCDA is a viable treatment option for reconstructing flexible flatfoot deformity. Although good clinical and radiographic outcomes were obtained, our method is even more challenging than conventional methods and should be used with caution. Rigid locking fixation with a long period of protected weightbearing is highly recommended to attain uneventful bone healing.

Calcaneocuboid distraction arthrodesis for children with symptomatic pes planovalgus: does fixation improve outcomes?

“…Several studies have suggested that adding stability with a locking plate and screws may stabilize the environment sufficiently for the graft to heal [2,17,18,25,36]. The etiology of graft collapse is secondary to both mechanical and biologic factors [2,39].…”

“…Isolated CCDA has been shown to minimally limit hindfoot motion while eliminating the risk of CC subluxation, increased CC joint pressure, and subsequent degenerative changes when performing a calcaneal lengthening osteotomy [19][20][21][22][23][24]. Historically, this procedure was performed without supplemental fixation but was prone to poor results due to graft collapse, nonunion, and subsequent loss of correction [2,15,25,26]. In 2010, our institution began to supplement this procedure with the use of locking plate fixation at the discretion of the attending surgeon in an effort to improve healing rates, reduce graft failure, and optimize correction.…”

Use of autologous bone grafting from the calcaneus and interconnected porous hydroxyapatite ceramic for bone transplantation in rheumatoid foot surgery

“… 16 , 17 Furthermore, other orthobiologics and other synthetic bone grafts including cellular bone allograft containing mesenchymal stem cells, bone marrow aspirate, platelet-derived growth factor, platelet-rich plasma, bone morphogenetic protein, fatal tissue, and demineralized bone matrix are also recommended for foot and ankle surgery. 18 – 20 However, at present, there are many actual cases for which allografts and other orthobiologics are not available in Japanese hospitals or Japanese health insurance systems. In such situations, combination of calcaneal bone with IP-CHA (NEOBONE®) was also useful for relatively larger bony defects (1.5–2.0 cm) in subtalar joint.…”

Reconstruction of Load-Bearing Segmental Bone Defects Using Carbonate Apatite Honeycomb Blocks

“…The CAp HC blocks that were fabricated using debinding temperatures of 600, 650, and 700 °C were labeled as HC-600, HC-650, and HC-700, respectively. A high-strength clinically used β-TCP block with a three-dimensional (3D) porous structure (Olympus Terumo Biomaterials Co., Ltd., Tokyo, Japan; Osferion Marvelous) was selected as the control block because it is widely applied in orthopedic surgery of loading limbs. − …”

“…Generally, synthetic bone blocks are used to clinically treat the defect in osteotomy surgeries of loading limbs. − Therefore, the effects of the pore characteristics in blocks on mechanical strength, osteoconductivity, and bioresorbability should be evaluated by implanting blocks in load-bearing segmental defects. However, previous studies have investigated the effect of the pore characteristics in synthetic bone blocks on bone reconstruction using nonload-bearing bone defects. − Furthermore, while these studies did not evaluate the mechanical strength of the blocks, they did investigate osteoconductivity and bioresorbability.…”