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Noble DM, Sumpter A, Small B, Ruland JR, Cooper MT, Park JS, Perumal V. Clinical, Radiographic, and Patient-Reported Outcomes of First Metatarsophalangeal Interposition Arthrodesis Using Porous Titanium Wedges. Foot Ankle Spec 2023:19386400231218337. [PMID: 38130108 DOI: 10.1177/19386400231218337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND First metatarsophalangeal (MTP) arthrodesis is a common surgical procedure for addressing hallux MTP pathology. In the setting of revision procedures with significant bone loss, porous titanium wedges may provide an alternative to structural bone autograft or allograft. OBJECTIVE The purpose of this study is to report the clinical and radiographic outcomes achieved in first MTP interposition arthrodesis using porous titanium wedges. METHODS A retrospective analysis of 9 patients with a mean age 65.4 years (45-82 years) who underwent first MTP interposition arthrodesis with the use of porous titanium wedges from February 2014 to September 2017 was performed. Outcomes were assessed using both plain-film radiographs and computed tomography (CT) scans, as well as patient-reported outcome measures, including Foot and Ankle Ability Measure (FAAM) (Sports and Activities of Daily Living), pain Visual Analogue Scale (VAS), and 36-Item Short Form Survey (SF-36). Average follow-up time was 34.2 months (14-72 months). RESULTS At final follow-up, the average FAAM score was 91.1 ± 14.7 (75.1 ± 5.3 FAAM Activities of Daily Living; 17.9 ± 9.9 FAAM Sports). Average pain VAS score was 1.9 ± 1.7. Postoperative computed tomography (CT) imaging was obtained for 5 patients, all of which demonstrated good bony apposition or osseous integration of the wedge. Four patients underwent subsequent surgical procedures, including 3 isolated dorsal fixation revisions, and 1 complete MTP arthrodesis revision. CONCLUSION To our knowledge, this study represents the first reported clinical and radiographic outcomes in patients undergoing first MTP interposition arthrodesis with use of porous titanium wedges. While we found this technique to be a viable alternative to bone grafting for this difficult problem, further research should focus on comparative data with other commonly performed operative techniques. LEVEL OF EVIDENCE Level IV: Case series.
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Affiliation(s)
- David M Noble
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Anna Sumpter
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Benjamin Small
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Jeffrey R Ruland
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - M Truitt Cooper
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Joseph S Park
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Venkat Perumal
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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Stamatos NJ, Murasko MJ, Richardson K, O’Connor C, Anoushiravani AA, Adams C, Rosenbaum A. Radiographic Outcomes of Titanium Augment vs Bone Graft in Lateral Column Lengthening for Adult-Acquired Flatfoot Deformity. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231176554. [PMID: 37325693 PMCID: PMC10262613 DOI: 10.1177/24730114231176554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
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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Affiliation(s)
| | - Marlon J. Murasko
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Kyle Richardson
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Casey O’Connor
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | | | - Curtis Adams
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Andrew Rosenbaum
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
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Sequeira SB, Burke JF, Casp A, Cooper MT, Park JS, Perumal V. Functional Activity After Flatfoot Reconstruction With Lateral Column Lengthening. Foot Ankle Spec 2022:19386400221116467. [PMID: 36000219 DOI: 10.1177/19386400221116467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The objective of this study was to evaluate return to activity following flatfoot reconstruction with lateral column lengthening (LCL) by assessing functional postoperative data and identifying patient characteristics associated with poor function following surgery. METHODS Consecutive patients that underwent operative flatfoot correction including LCL and other necessary procedures from 2014 to 2019 by 3 fellowship trained foot and ankle orthopedic surgeons were retrospectively administered Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and FAAM Sports questionnaires with no preoperative scoring available. Patient demographic factors, comorbidities, and radiographic features were evaluated as predictors of outcome scores to simulate return to activity. Statistical analysis, including student's t-tests and analysis of variance, was performed. RESULTS A total of 54 patients were included. A body mass index (BMI) of 30 kg/m2 or greater was associated with a lower ADL score (P = .002) and Sports score (P = .002). Preoperative hindfoot valgus of 9° or higher was associated with higher ADL scores (P = .040). Neither age nor any flatfoot radiographic parameters yielded significant differences in functional scores. CONCLUSION This study demonstrated relatively high average FAAM scores in both the ADL and the sports subscales, consistent with previous studies. This study also identified lower BMI and greater preoperative hindfoot valgus as potential predictors of improved functional outcome following reconstruction. LEVEL OF EVIDENCE Level III: Retrospective case control.
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Affiliation(s)
- Sean B Sequeira
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia (SBS, JFB, AC, MTC, JSP, VP)
| | - John F Burke
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia (SBS, JFB, AC, MTC, JSP, VP)
| | - Aaron Casp
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia (SBS, JFB, AC, MTC, JSP, VP)
| | - Minton T Cooper
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia (SBS, JFB, AC, MTC, JSP, VP)
| | - Joseph S Park
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia (SBS, JFB, AC, MTC, JSP, VP)
| | - Venkat Perumal
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia (SBS, JFB, AC, MTC, JSP, VP)
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Guo Y, Liu F, Bian X, Lu K, Huang P, Ye X, Tang C, Li X, Wang H, Tang K. Effect of Pore Size of Porous-Structured Titanium Implants on Tendon Ingrowth. Appl Bionics Biomech 2022; 2022:2801229. [PMID: 35510044 PMCID: PMC9061050 DOI: 10.1155/2022/2801229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/27/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The reconstruction of a tendon insertion on metal prostheses is a challenge in orthopedics. Of the available metal prostheses, porous metal prostheses have been shown to have better biocompatibility for tissue integration. Therefore, this study is aimed at identifying an appropriate porous structure for the reconstruction of a tendon insertion on metal prostheses. Methods Ti6Al4V specimens with a diamond-like porous structure with triply periodic minimal surface pore sizes of 300, 500, and 700 μm and a porosity of 58% (designated Ti300, Ti500, and Ti700, respectively) were manufactured by selective laser melting and were characterized with micro-CT and scanning electron microscopy for their porosity, pore size, and surface topography. The porous specimens were implanted into the patellar tendon of rabbits. Tendon integration was evaluated after implantation into the tendon at 4, 8, and 12 weeks by histology, and the fixation strength was evaluated with a pull-out test at week 12. Results The average pore sizes of the Ti300, Ti500, and Ti700 implants were 261, 480, and 668 μm, respectively. The Ti500 and Ti700 implants demonstrated better tissue growth than the Ti300 implant at weeks 4, 8, and 12. At week 12, the histological score of the Ti500 implant was 13.67 ± 0.58, and it had an area percentage of type I collagen of 63.90% ± 3.41%; both of these results were significantly higher than those for the Ti300 and Ti700 implants. The pull-out load at week 12 was also the highest in the Ti500 group. Conclusion Ti6Al4V implants with a diamond-like porous structure with triply periodic minimal surface pore size of 500 μm are suitable for tendon integration.
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Affiliation(s)
- Yupeng Guo
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Fei Liu
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Xuting Bian
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Kang Lu
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Pan Huang
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Xiao Ye
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Chuyue Tang
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Xinxin Li
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Huan Wang
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Kanglai Tang
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
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Crawford AW, Haleem AM. I am Afraid of Lateral Column Lengthening. Should I Be? Foot Ankle Clin 2021; 26:523-538. [PMID: 34332733 DOI: 10.1016/j.fcl.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Lateral column lengthening has long been used in conjunction with other soft tissue and bony procedures to correct the midforefoot abduction seen in class B progressive collapsing foot deformity. The effectiveness of this osteotomy to restore the physiologic shape of the foot has been used by foot and ankle surgeons around the world to provide functional improvement for patients suffering from this disease. The overall low complication rates, low nonunion rates, and improved radiographic and functional outcomes provided by lateral column lengthening make this a valuable option for the treatment of class B progressive collapsing foot deformity.
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Affiliation(s)
- Alexander W Crawford
- Department of Orthopedic Surgery, Oklahoma University Health Sciences Center, University of Oklahoma College of Medicine, 800 Stanton L Young Boulevard, Suite 3400, Oklahoma City, OK 73104, USA
| | - Amgad M Haleem
- Department of Orthopedic Surgery, Oklahoma University Health Sciences Center, University of Oklahoma College of Medicine, 800 Stanton L Young Boulevard, Suite 3400, Oklahoma City, OK 73104, USA; Department of Orthopedic Surgery, Kasr Al-Ainy Hospitals, College of Medicine, Cairo University, Cairo, Egypt.
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Döring K, Vertesich K, Puchner S. [Adult Acquired Flatfoot Deformity: Diagnosis and Surgical Treatment]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 160:107-126. [PMID: 33567455 DOI: 10.1055/a-1165-4994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The adult acquired flatfoot is a deformity with slow progression, which may leads to pain and restrictions of activities of daily living if untreated. Various treatment strategies, depending on the clinical and radiological presentation, exist. Therefore, an individual therapy approach is necessary for optimal treatment. This article covers etiopathologic aspects, conservative and operative treatments as well as postoperative mobilization and rehabilitation.
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Fraser TW, Kadakia AR, Doty JF. Complications and Early Radiographic Outcomes of Flatfoot Deformity Correction With Metallic Midfoot Opening Wedge Implants. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419868971. [PMID: 35097336 PMCID: PMC8696914 DOI: 10.1177/2473011419868971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Forefoot varus is a common component of flatfoot deformity that is often surgically addressed. Multiple options exist to plantarflex the medial column, with midfoot fusion and the Cotton osteotomy being the most common. This study analyzes radiographic outcomes and complications when a titanium wedge is used for structural support in a dorsal opening wedge Cotton osteotomy of the medial cuneiform. Methods: Between December 2016 and May 2018, 32 feet in 31 patients were treated with medial column titanium wedges for residual forefoot varus in association with flatfoot corrections. All participants had preoperative and weight-bearing postoperative radiographs examined for analysis of radiographic correction. The average age of the patients was 41.1 (range: 12-70). The average follow-up time for patients was 12.2 months (8-24). Results: All radiographic parameters were statistically significantly improved from preoperative to postoperative (P < .05). There were no instances of nonunion of the medial cuneiform osteotomy. There was 1 implant that loosened and was revised to a larger implant that healed uneventfully. No wedges were removed for continued pain at the osteotomy site. Conclusion: This study suggests that metal wedges are both safe and effective for use in medial column correction based on early follow-up data. Future studies comparing titanium wedges versus traditional bone grafting for Cotton osteotomies may provide further analysis of radiographic correction, operative time, procedure cost, and outcomes. There were no instances of pain over the titanium wedge site. Radiographic outcomes are similar to those reported for opening wedge Cotton osteotomies including bone grafting and wedge plates with screws. Future studies will help determine the long-term maintenance of correction and hardware survivorship. Level of Evidence: Level IV, case series.
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Affiliation(s)
- Tyler W. Fraser
- University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | | | - Jesse F. Doty
- University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
- Erlanger Health System, Chattanooga, TN, USA
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