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Lower surgical rates, fewer revision procedures seen with Ponseti method
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One of the first controlled, prospective studies comparing the results of the Ponseti method to surgical treatment for patients with clubfoot deformities shows lower surgical rates and fewer revision procedures with the conservative technique.
“The case for Ponseti treatment is much stronger than for surgery considering Ponseti treatment involves less severe recurrence; and feet treated with too many surgeries have less favorable outcomes,” Matthew Halanski, MD, an author of the study and orthopedic surgeon at the Helen DeVos Children’s Hospital in Grand Rapids, Michigan, stated in an American Academy of Orthopaedic Surgeons press release.
Operative intervention
The study appears in the February issue of The Journal of Bone and Joint Surgery.
Halanski and colleagues from the Starship Children’s Hospital in Auckland, New Zealand studied 55 patients with idiopathic clubfoot deformities (86 feet). Forty feet were treated with the Ponseti method and 46 feet underwent below-the-knee casting followed by surgery, according to the study abstract. The Ponseti group used an average of six casts compared to 13 casts for the surgical group.
The investigators found 15 operative interventions for recurrences in the Ponseti group, including four major and 11 minor surgeries. In addition, they discovered that only one foot in the group required revision surgery. The investigators found 14 surgical revisions in the comparison group. The study also revealed a 30% to 40% relapse rate in both groups, according to the release.
“Any infant born with clubfoot should be taken to an orthopedic surgeon specializing in pediatrics, preferably within the first few months of life,” Halanski stated in the release. “While primary surgical treatment may still be required in select cases, we strongly advise any parent who receives a recommendation for surgery as primary treatment to seek a second opinion.”– by Gina Brockenbrough
Reference:
- Matthew A. Halanski, MD, Jan E. Davison, NZRGON, Jen-Chen Huang, MBChB, et al. Ponseti method compared with surgical treatment of clubfoot: A prospective comparison. J. Bone Joint Surg. Am., Feb 2010; 92: 270 - 278.
- www.aaos.org
Patients treated in both groups had a similar recurrence rate. While this is a relatively high recurrence rate for both groups, feet in the Ponseti group not only had less severe recurrences, but also required less operative intervention and less revision surgery. The surgical group who required revision surgery, for the most part, had to undergo a surgery which has been shown to lead to poorer function in several studies.
The Ponseti method has been popular in the United States for some time and should continue to be considered a primary treatment for clubfoot. This study certainly supports this method and confirms the high recurrence rate, regardless of the treatment.
– Carol C. Frey, MD,
Orthopedics
Today Foot & Ankle Section Editor