Long-Term Outcomes of Corrective Osteotomies Using Porous Titanium Wedges for Flexible Flatfoot Deformity Correction

Matthews, Michael R.; Cook, Emily; Cook, Jeremy J.; Johnson, Lindsay J.; Karthas, Timothy; Collier, Byron; Hansen, Daniel; Manning, Elena; McKenna, Bryon; Basile, Philip

doi:10.1053/j.jfas.2018.03.015

Cited by 20 publications

(23 citation statements)

References 13 publications

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“…39,53,89 As an alternate to bone graft, studies have reported that porous titanium wedges also provide good correction with low nonunion rates. 54,84 Optimal LCL graft size may be determined by literature-based formulas, in which each additional millimeter of lengthening performed corresponds to a 6.8-degree change in lateral incongruency angle. 22 The amount of graft is typically 4 to 8 mm, the amount required to correct forefoot abduction without losing all eversion.…”

Section: Forefoot Abductionmentioning

confidence: 99%

Adult-Acquired Flatfoot Deformity

Henry

Shakked

Ellis

2019

Foot & Ankle Orthopaedics

148

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Adult-acquired flatfoot deformity (AAFD) comprises a wide spectrum of ligament and tendon failure that may result in significant deformity and disability. It is often associated with posterior tibial tendon deficiency (PTTD), which has been linked to multiple demographic factors, medical comorbidities, and genetic processes. AAFD is classified using stages I through IV. Nonoperative treatment modalities should always be attempted first and often provide resolution in stages I and II. Stage II, consisting of a wide range of flexible deformities, is typically treated operatively with a combination of soft tissue procedures and osteotomies. Stage III, which is characterized by a rigid flatfoot, typically warrants triple arthrodesis. Stage IV, where the flatfoot deformity involves the ankle joint, is treated with ankle arthrodesis or ankle arthroplasty with or without deltoid ligament reconstruction along with procedures to restore alignment of the foot. There is limited evidence as to the optimal procedure; thus, the surgical indications and techniques continue to be researched.

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Section: Forefoot Abductionmentioning

confidence: 99%

Adult-Acquired Flatfoot Deformity

Henry

Shakked

Ellis

2019

Foot & Ankle Orthopaedics

148

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“…Based on a 4-year multicenter retrospective review, this group demonstrated that the radiographic corrections were maintained with no major complications or implant removal or migration. 19 Expanding on this foundation, our study demonstrated that porous titanium wedge augments have similar clinical outcomes when directly compared with traditional bone grafting. For this, we compared the postoperative radiographic outcomes following LCL with a porous titanium wedge vs autograft or allograft.…”

Section: Discussionmentioning

confidence: 59%

“…12 Although allografts do not carry the same risks and limitations, they are considered to be less osteogenic, associated with higher rates of nonunion, and carry the possibility of immunogenicity and disease transmission. 19,27 With the rising need for bone graft alternatives, along with advances in synthetic bone grafting technology, porous titanium metal implants have been turned to with the hope of decreasing risk of nonunion as well as donor site morbidity. 24,26 Despite the promise of this technology, there are limited studies on its efficacy and safety among patients who received LCL.…”

Section: Discussionmentioning

confidence: 99%

“…7,10,16,27 Recent research has focused on alternative graft options to mitigate these risks leading to the introduction of porous titanium wedges. 12,19,21,24 Porous metal implant's unique characteristics offer improved fixation by allowing for biologic ingrowth through the porous metal matrix, and these consequently increase their popularity in orthopaedic reconstructive procedures. 24 In 2010, Tucker 26 described the first use of porous titanium wedges in LCL as an alternative to traditional bone grafting.…”

Section: Introductionmentioning

confidence: 99%

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Radiographic Outcomes of Titanium Augment vs Bone Graft in Lateral Column Lengthening for Adult-Acquired Flatfoot Deformity

Stamatos

Murasko

Richardson

et al. 2023

Foot & Ankle Orthopaedics

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Background: Lateral column lengthening (LCL) is a surgical procedure used to manage forefoot abduction and, in theory, also increases the longitudinal arch by plantarflexion of the first ray through tensioning the peroneus longus for patients with stage IIB adult acquired flatfoot deformity (AAFD). This procedure utilizes an opening wedge osteotomy of the calcaneus, which is then filled with autograft, allograft, or a porous metal wedge. The primary aim of this study was to compare the radiographic outcomes of these different bone substitutes following LCL for stage IIB AAFD. Methods: We conducted a retrospective review of all patients who underwent LCL from October 2008 until October 2018. Preoperative weightbearing radiographs, initial postoperative radiographs, and 1-year weightbearing radiographs were reviewed. The following radiographic measurements were recorded: incongruency angle, talonavicular coverage angle (TNCA), talar–first metatarsal angle (T-1MT), and calcaneal pitch. Results: A total of 44 patients were included in our study. The mean age of the cohort was 54 (range, 18-74). The study cohort was divided into 2 groups. There were 17 (38.7%) patients who received a titanium metal wedge and 27 (61.5%) that received autograft or allograft. Patients that underwent LCL with the autograft/allograft group were significantly older (59 vs 47 years old, P = .006). Patients who underwent LCL with a titanium wedge had a significantly higher preoperative talonavicular angle (32 vs 27 degrees, P = .013). There were no significant differences in postoperative TNCA, incongruency angle, or calcaneal pitch at 6 months or 1 year. Conclusion: At 6 months and 1 year, no radiographic differences were found between autograft/allograft bone substitutes vs titanium wedge in LCL. Level of Evidence: Level III, retrospective cohort study.

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“…However, a trabecular titanium wedge has not the structural characteristics of bone and may be subject to long-term mobilization or intolerance. Matthwes et al in a recent paper reported clinical and radiological outcomes of patients treated with Cotton osteotomy, using a titanium wedge [28]. They found a 100% incorporation rate but one patient reported painful hardware.…”

Section: Discussionmentioning

confidence: 99%

Medial Cuneiform Opening Wedge Osteotomy for Correction of Flexible Flatfoot Deformity: Trabecular Titanium vs. Bone Allograft Wedges

Romeo

Bianchi

Cerbone

et al. 2019

BioMed Research International

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Adult flatfoot is a common pathology characterized by multiplanar deformity involving hindfoot, midfoot, and forefoot. Various surgical techniques have been described for the treatment but may not adequately correct the fixed forefoot varus component. Residual forefoot supination can be addressed by a plantar flexing opening wedge osteotomy of the medial cuneiform, also known as a Cotton osteotomy. Thus, the aims of this study were to compare clinical, radiological, and functional outcome after Cotton osteotomy, in patients treated with bone allograft or metallic implant. Consequently, 36 patients treated with opening wedge osteotomy of the medial cuneiform for forefoot varus were studied retrospectively. Patients were divided into two groups: the bone allograft group (HBG) (n=18) and the metallic implant group with BIOFOAM® Cotton Wedges (TTW) (n=18). Radiographic assessment and clinical scores including American Orthopaedic Foot and Ankle Society score, Foot Function Index, and visual analogue scale for pain were collected before operation and the last follow-up. The difference between baseline and follow-up for both groups was statistically significant for all the clinical scores and radiographic angles (p < 0.05). Most participants (92%) were very satisfied after surgery. Our results showed that Cotton osteotomy with a metallic implant provided both good clinical and radiographic outcomes comparable with bone allograft.

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Long-Term Outcomes of Corrective Osteotomies Using Porous Titanium Wedges for Flexible Flatfoot Deformity Correction

Cited by 20 publications

References 13 publications

Adult-Acquired Flatfoot Deformity

Adult-Acquired Flatfoot Deformity

Radiographic Outcomes of Titanium Augment vs Bone Graft in Lateral Column Lengthening for Adult-Acquired Flatfoot Deformity

Medial Cuneiform Opening Wedge Osteotomy for Correction of Flexible Flatfoot Deformity: Trabecular Titanium vs. Bone Allograft Wedges

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