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Midfoot arthrodesis viable in treatment of primary midfoot arthritis, study finds
With a patient satisfaction rate higher than 90%, one physician called the results “excellent.”
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Midfoot arthrodesis is an effective procedure for the treatment of primary midfoot arthritis following the failure of conservative methods, according to recent research.
The findings were presented by Scott A. Nemec, DO, at the 2010 Annual Meeting of the American Orthopaedic Foot and Ankle Society (AOFAS).
Midfoot arthrodesis, Nemec reported, achieved “excellent” patient satisfaction, high union and low complication rates. Deformities arising out of midfoot collapse can also be corrected concurrently.
Nemec’s retrospective study included 95 patients — a total of 104 feet — who had undergone midfoot arthrodesis for primary midfoot arthritis between 2000 and 2006. The indication for surgery was presence of pain despite adequate nonoperative management. Midfoot collapse was corrected at the time of arthrodesis if present.
Gastrocnemius contracture was reported in 78% of the feet investigated, and overall, 297 individual midfoot joints were arthrodesed.
 Scott A. Nemec |
Nemec’s group evaluated complications and reoperations, reviewed radiographs for correction of deformity and evaluated outcomes via pain score, AOFAS midfoot score, and patient satisfaction.
“Our hypothesis was that midfoot arthrodesis is an excellent procedure for primary midfoot arthritis, and that it can achieve good results with acceptable rates of complication,” Nemec said.
Positive results
According to Nemec, union was achieved in 96 of 104 feet (92.3%) after the primary procedure and 103 of 104 feet (99%) after revision arthrodesis, with one asymptomatic nonunion. Individual joint union was achieved in 287 of 297 joints (96.6%) after the primary procedure and 295 of 297 (99%) after revision.
“Hardware was removed from 26 out of 104 feet at a mean of about 19-and-a-half months,” Nemec said.
There were 12 complications — including eight nonunions, three deep infections and one incident of complex regional pain syndrome. Seven revision arthrodesis operations were completed, and there were 11 reoperations in total.
“A safe procedure”
In all, Nemec said, 68 patients — 74 feet — were able to follow-up with functional outcomes over a mean of 56 months. Pain scores improved, as did the mean AOFAS score. According to the results of the study, more than 90% of patients were satisfied with their functional outcomes.
No statistically significant differences in union rates, pain and AOFAS scores were found between smokers and non-smokers or patients with or without diabetes, though Nemec did make it a point to mention that patients with a body mass index greater than 30 were more susceptible to complications or poor results.
“It is a safe procedure with excellent union rate, high patient satisfaction and an acceptable complication rate,” Nemec concluded. – by Robert Press
Reference:
- Nemec SA, Habbu RA, Bohay DR, Anderson JG. Primary midfoot arthritis: Functional outcomes following midfoot arthrodesis. Presented at the 2010 Annual Meeting of the American Orthopaedic Foot and Ankle Society. July 8-10. National Harbor, Md
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