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Whitelaw K, Shah S, Hagemeijer NC, et al. Fusion Versus Joint-Sparing Reconstruction for Patients With Flexible Flatfoot. Foot Ankle Spec. 2020;1938640020950552doi: 10.1177/1938640020950552.
Whitelaw, K., Shah, S., Hagemeijer, N. C., Guss, D., Johnson, A. H., & DiGiovanni, C. W. (2020). Fusion Versus Joint-Sparing Reconstruction for Patients With Flexible Flatfoot. Foot & ankle specialist, 1938640020950552. https://doi.org/10.1177/1938640020950552
Whitelaw, Kathryn, et al. "Fusion Versus Joint-Sparing Reconstruction for Patients With Flexible Flatfoot." Foot & ankle specialist vol. (2020): 1938640020950552. doi: https://doi.org/10.1177/1938640020950552
Whitelaw K, Shah S, Hagemeijer NC, Guss D, Johnson AH, DiGiovanni CW. Fusion Versus Joint-Sparing Reconstruction for Patients With Flexible Flatfoot. Foot Ankle Spec. 2020 Aug 24;1938640020950552. doi: 10.1177/1938640020950552. Epub 2020 Aug 24. PMID: 32830570.
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Foot Ankle Spec. 2020 Aug 24;1938640020950552. doi: 10.1177/1938640020950552. Epub 2020 Aug 24.

Fusion Versus Joint-Sparing Reconstruction for Patients With Flexible Flatfoot.

Foot & ankle specialist

Kathryn Whitelaw, Shivesh Shah, Noortje C Hagemeijer, Daniel Guss, Anne H Johnson, Christopher W DiGiovanni

Affiliations

  1. School of Medicine, Georgetown University, Washington, DC (KW).
  2. Massachusetts General Hospital, Boston, Massachusetts (KW, SS, NCH, DG, CWD).
  3. Hospital for Special Surgery, New York, New York (AHJ).

PMID: 32830570 DOI: 10.1177/1938640020950552

Abstract

AIMS: Passively correctible, adult-acquired flatfoot deformities (AAFD) are treated with joint-sparing procedures. Questions remain as to the efficacy of such procedures when clinical deformities are severe. In severe deformities, a primary fusion may lead to predictable outcomes, but risks nonunion. We evaluated pre- and postsurgical flexible AAFD patients undergoing joint-sparing or fusion procedures, comparing reoperation and complication rates.

METHODS: We identified patients with flexible AAFD between January 1, 2001 and 2016. Exclusion criteria were incomplete medical record, rigid AAFD, and prior flatfoot surgery. Patient demographics, pre- and postsurgical radiographic measurements, surgery performed, and postoperative complications were evaluated by bivariate analysis, comparing joint-sparing versus fusion procedures.

RESULTS: Of 239 patients (255 feet) (mean follow-up 62 ± 50 months), 209 (87%) underwent joint-sparing reconstructions, 30 (12.6%) underwent fusions. Fifty-four (24.1%) feet underwent joint-sparing reconstruction with reoperation versus 11 (35.5%) in fusion patients (

DISCUSSION: More nonunion reoperations among fusion patients were offset by reoperations in joint-sparing patients. Fusion uniquely corrected Meary's angle. Nonunion is of less concern for joint-sparing versus fusion for patients with severe flexible AAFD. Degree of deformity versus advantage of joint motion should improve decision making.

LEVELS OF EVIDENCE: Level IV: Retrospective case series.

Keywords: adult-acquired flatfoot deformities (AAFD); flexible flatfoot; fusion; reconstruction

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