Minimally invasive technique for stage III adult-acquired flatfoot deformity: a mid- to long-term retrospective study

Tejero, Sergio; Carranza-Pérez-Tinao, Andres; Zambrano-Jiménez, Maria Dolores; Prada-Chamorro, Estefanía; Fernández-Torres, José Juan; Carranza-Bencano, Andrés

doi:10.1007/s00264-020-04724-5

Cited by 11 publications

(14 citation statements)

References 21 publications

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“…Post-operatively, the double arthrodesis group had a significant correction of Meary’s angle, calcaneal pitch, medial cuneiform-5th metatarsal height, talonavicular coverage angle indicative of successful correction of the planus and abduction deformities, and restoration of the medial longitudinal arch. Our findings on deformity correction are consistent with those reported by other studies on double arthrodesis [ 16 – 18 , 20 – 22 ].…”

Section: Discussionsupporting

confidence: 93%

“…All patients in the double arthrodesis groups in our study achieved good to excellent AOFAS hindfoot score post-operatively with a mean of 88.4 ± 3.7 out of 94 attainable points as the six points awarded for STJ motion are lost with successful arthrodesis. This favourable outcome was consistent among most of the studies [ 18 , 20 , 21 ]. Notably, the AOFAS score improvement was greater in the triple arthrodesis group than the double arthrodesis group 19.1 ± 5.63 vs. 16.9 ± 7.12, respectively.…”

Section: Discussionsupporting

confidence: 86%

“…A few studies reported on the outcomes of double arthrodesis. Most of these studies were retrospective [17][18][19][20][21]24], lacked a comparative group of triple arthrodesis [17][18][19][20][21][22], and/or included a heterogeneous group of pathologies not limited to AAFD due to PTTI [18,21]. We aimed to avoid these limitations through a rigorous methodology and inclusion/exclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

“…This protective effect on adjacent joints is also supported by Sammarco et al and Hyer et al [ 18 , 23 ]. Recently, Tejero et al reported that only 4 out of 67 (5.9%) feet with double arthrodesis developed deformity progression and required ankle arthrodesis at 6.6 years of follow-up [ 20 ]. In contrast, triple arthrodesis has a reported rate of deformity progression of up to 38% [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…In modern literature, double arthrodesis has been proven to restore function and provide a plantigrade foot [16][17][18][19][20][21][22]. Moreover, double arthrodesis has been shown to be protective against post-operative ankle valgus when compared to triple arthrodesis [23].…”

Section: Introductionmentioning

confidence: 99%

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Double versus triple arthrodesis for adult-acquired flatfoot deformity due to stage III posterior tibial tendon insufficiency: a prospective comparative study of two cohorts

Fadle

El-Adly

Attia

et al. 2021

International Orthopaedics (SICOT)

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Purpose The study aims to prospectively compare double and triple arthrodesis in terms of functional outcomes and deformity correction. To the best of our knowledge, this is the first prospective comparative study in the literature to date. Methods This is a prospective comparative cohort study carried out between May 2017 and May 2019. The study was approved by the IRB at Assiut University and done according to the Helsinki declaration. Patients with AAFD stage III aged between 15 and 40 years old were assigned to double arthrodesis or triple arthrodesis. The groups were prospectively followed for one year. Primary outcomes were union rates, AOFAS scores, and radiological parameters of deformity correction on AP and lateral plain radiographs. Secondary outcomes were operative time, time to union, and complications. The double arthrodesis was done through the medial approach, while the triple arthrodesis was done through dual medial and lateral approaches. The post-operative protocol was standardized for both groups. Results A total of twenty-three patients matched the inclusion criteria and provided their consent to participate in the study. Thirteen (all males) patients underwent double arthrodesis, while ten (nine males and one female) patients underwent triple arthrodesis. The mean age for double and triple arthrodesis was 20.15 ± 5.63 and 25.10 ± 8.36 years, respectively, and the mean follow-up lengths were 12.46 and 12.9 months, respectively. There were no statistically significant differences between both groups in age, gender, laterality, or duration of follow-up. There were no statistically significant differences between both groups in AOFAS hindfoot scores or radiographic parameters. All patients were available for the final follow-up evaluation. All patients in both groups achieved union by four months post-operatively. The mean time to union in the double and triple arthrodesis groups was 3.39 ± 0.65 vs. 3.31 ± 0.6 months, respectively, with no statistically significant differences (p = 0.77). The mean operative time was significantly shorter in the double arthrodesis group than the triple arthrodesis group, 55.77 ± 15.18 vs. 91.6 ± 24.14 min (p < 0.001), respectively. Both double and triple arthrodesis groups had a statistically significant improvement of the mean AOFAS hindfoot score post-operatively (71.46 ± 7.77 vs. 88.38 ± 3.66, p < 0.001) and (66.9 ± 7.69 vs. 85 ± 5.83, p < 0.001), respectively. In the double arthrodesis group, the mean calcaneal pitch angle increased from 11.46° pre-operatively to 19.34° (MD = 8.45°, p < 0.001). The mean Meary’s angle improved from − 4.19 to 2.9° (MD = 7.32°, p < 0.001). Hibbs angle had a mean reduction of 6.45° post-operatively (p = 0.069). In the triple arthrodesis group, the mean calcaneal pitch angle improved from 10.06° pre-operatively to 17.49° post-operatively (MD = 7.12°, p < 0.001). The mean Meary’s angle improved from − 4.72 to 2.29° (MD = 7.09°, p < 0.001). The mean Hibbs angle decreased from 153.07 to 142.32° (MD = 10.54°, p < 0.001). The double vs. triple arthrodesis groups had no statistically significant differences in AOFAS hindfoot score improvement (16.92 vs. 19.1, p = 0.44), respectively. The two groups had no statistically significant differences in the magnitude of correction of all the radiographic parameters. Conclusion Double arthrodesis is an equally reliable surgical option for AAFD stage III for achieving union, improving the functional outcomes, and deformity correction as triple arthrodesis with a significantly shorter operative time in the former. The authors recommend double arthrodesis if the calcaneocuboid joint is unaffected.

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