Outcome after subtalar screw arthroereisis in children with flexible flatfoot depends on time of treatment: Midterm results of 95 cases

Kubo, Hannes; Lipp, Carina; Hufeland, Martin; Ruppert, Martin; Westhoff, Bettina; Krauspe, R.; Pilge, Hakan

doi:10.1016/j.jos.2019.06.007

Cited by 18 publications

(62 citation statements)

References 14 publications

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“…In juvenile FFFs the most median age at treatment is 8 to 14 years of age, but only when the pain is persistent after conservative treatment[ 19 ]. Kubo et al [ 20 ], considering bone maturation stage, found that the best deformity correction was achieved when surgically was performed between 9 and 12 years of age, without secondary deterioration during follow-up.…”

Section: Discussionmentioning

confidence: 99%

Arthroereisis in juvenile flexible flatfoot: Which device should we implant? A systematic review of literature published in the last 5 years

Vescio

Testa

Amico

et al. 2021

WJO

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BACKGROUND Flexible flatfoot (FFF) is a very common condition in children, characterized by the loss of the medial arch and by an increase in the support base with valgus of the hindfoot. Arthroereisis (AR) procedures are widely performed corrective surgeries and are classified as subtalar AR and calcaneo-stop (CS). AIM We investigated the literature published in the last 5 years with the aim of providing an update on the evidence related to AR treatment in FFF patients. We report the principal findings of subtalar AR and CS procedures concerning clinical and radiological outcomes and complication rates in the general population, young athletes, and obese people according to material device. METHODS Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of studies published in the past 5 years and included the PubMed and Science Direct databases was performed on May 6, 2020. The research string used was (pediatric OR children OR Juvenile NOT adult) AND (flexible NOT rigid) AND (flat foot OR pes planus) AND (calcaneo-Stop OR arthroereisis OR subtalar extra-articular screw OR SESA OR subtalar arthroereisis OR endosinotarsal). The risk of bias assessment was performed using the Dutch checklist form for prognosis. RESULTS A total of 47 articles were found. Ultimately, after reading the full text and checking reference lists, we selected 17 articles that met the inclusion and exclusion criteria. A total of 1864 FFFs were identified. Eight studies concerned the subtalar AR (47.1%) and nine concerning CS (52.9%). The average age of patients at start of treatment was 11.8 years, the average follow-up of the studies was 71.9 mo (range 29.1-130). Globally, complications occurred in 153 of the 1864 FFF treated, with a rate of 8.2%. CONCLUSION Both AR procedures are valid surgical techniques for treating FFF. Surgeon experience, implant cost, and cosmetic correction are the most common considerations included in the orthopedic device decision-making process. In obese patients, the subtalar AR is not recommended. In adolescents who need to improve sports performance, the CS screw had better results compared with other implants.

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Section: Discussionmentioning

confidence: 99%

Arthroereisis in juvenile flexible flatfoot: Which device should we implant? A systematic review of literature published in the last 5 years

Vescio

Testa

Amico

et al. 2021

WJO

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“…In terms of the patient population, 6 studies performed with endosinotarsal cone shaped implant [20][21][22][23] , 5 studies performed with exosinotarsal screw [24][25][26][27][28][29] , while one study performed with both surgeries were divided into two groups 1 .…”

Section: Resultsmentioning

confidence: 99%

“…We suggest three possible explanations (there may be more). First, the exosinotarsal metallic screw implant had less contact area to bone than endosinotarsal implants, which may lead to bone erosion and consequent less corrective effect 1,24 . Second, the variable screw purchase to calcaneus may lead to screw loosening after repeated subtalar motion.…”

Section: Discussionmentioning

confidence: 99%

“… The range of age distribution is relatively wide in both endosinotarsal cone group or exosinotarsal screw group. According to study of Kubo et al 24 , the best time for the surgeries is 9–12 years old. According to Hsieh et al, most of their patients underwent endosinotarsal implants were before the age of 10, suggesting less bone remodeling in older children.…”

Section: Discussionmentioning

confidence: 99%

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Endosinotarsal device exerts a better postoperative correction in Meary’s angle than exosinotarsal screw from a meta-analysis in pediatric flatfoot

Hsieh

Lee

Tseng

et al. 2020

Sci Rep

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reviewed for relevant reference. Literature not written in English, not available in full text, adult patients, focus on gait analysis, review articles, patients with neuromuscular diseases, case reports, or techniques except exosinotarsal subtalar screw in calcaneus or endosinotarsal cone-shaped implant were excluded. We investigated studies using endosinotarsal tunnel subtalar arthroereisis for pediatric flexible flatfoot treatment. The search strategy comprised the following keywords combined with subtalar arthroereisis: flexible flatfoot and pes planus. Regarding the types of included studies, we enrolled randomized controlled trials (RCTs), comparative experimental trials, or single-armed follow up studies. We excluded case series and case reports. The target population comprised pediatric patients who suffered from painful flexible flatfoot.

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“…According to Tong and Kong [3], medical longitudinal arch development of children stabilized between the age of seven and nine. Kubo et al [4] indicated that the optimal time for a child to undergo subtalar screw arthroereisis is between the age of 9 and 12. Notably, the foot and foot arch at these ages are immature and still developing.…”

Section: Discussionmentioning

confidence: 99%

Body Weight Effects on Extra-Osseous Subtalar Arthroereisis

Hsieh

Lee

Tseng

et al. 2019

JCM

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Implant extrusion in subtalar arthroereisis is a common complication for pediatric flexible flatfoot. However, there were a limited number of articles addressing the body weight effects on implant extrusion after the procedure. We conducted a 24-month follow-up assessment after subtalar arthroereisis. Surgical patients who underwent the Vulpius procedure were retrospectively collected from May 2010 to January 2017, including 59 cases of both feet having implants in situ and 43 cases of both feet having implant extrusion. The average age of 102 patients was 9 years old. The mean body mass index (BMI) of the implant in situ group was 19.5, whilst the extrusion group was 21.2 (p = 0.035). The inter-observer correlation was excellent. There were 11 cases (39.3%) of bilateral extrusion in the overweight group (BMI ≥ 24) and 13 cases (23.2%) in the low body weight group (BMI ≤ 18.5) (p < 0.0004). Postoperative radiographic angles were corrected in both the implant in situ group and the extrusion group. Nonetheless, the implant in situ group revealed better postoperative outcomes of Meary’s angle and the talonavicular angle from an anterior-posterior view, and the talar inclination angle from a lateral view. We conclude that a higher BMI is related to implant extrusion and worse results after subtalar arthroereisis. Further prospective study to investigate whether preoperative weight loss results in improved surgical outcomes is warranted in the future.

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Outcome after subtalar screw arthroereisis in children with flexible flatfoot depends on time of treatment: Midterm results of 95 cases

Cited by 18 publications

References 14 publications

Arthroereisis in juvenile flexible flatfoot: Which device should we implant? A systematic review of literature published in the last 5 years

Arthroereisis in juvenile flexible flatfoot: Which device should we implant? A systematic review of literature published in the last 5 years

Endosinotarsal device exerts a better postoperative correction in Meary’s angle than exosinotarsal screw from a meta-analysis in pediatric flatfoot

Body Weight Effects on Extra-Osseous Subtalar Arthroereisis

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