Arthrodesis of the Foot or Ankle in Adult Patients with Congenital Clubfoot

The effect of early weight-bearing on bone fusion after triple arthrodesis

Triple arthrodesis is an effective method for treating stiff horseshoe feet and severe osteoarthritis. However, it is still a challenge to improve postoperative bone fusion by changing early weight-bearing. This study improved the classical bone remodeling algorithm, established a mathematical relationship between density change rate and mechanical stimulation, and combined it with finite element theory. The proposed algorithm can not only predict the effect of early weight-bearing on triple arthrodesis but also visually demonstrate the change of bone mineral density with time. The analysis results indicated that 2.5% of the initial load was a potential factor leading to bone nonunion, and 50% of the initial load would result in bone resorption. Meanwhile, it was found that 25% of the external load was more conducive to postoperative rehabilitation. The study results have theoretical significance for enhancing the effect of postoperative bone fusion and formulating a more scientific rehabilitation program, thereby supporting patients' postoperative rehabilitation exercise.

Clinical application of 3D printing-assisted patient-specific instrument osteotomy guide in stiff clubfoot: preliminary findings

BACKGROUND

The orthopedic treatment of the stiff clubfoot is challenging for clinicians, and the purpose of this study was to explore the preliminary findings of 3D printing-assisted patient-specific instrument (PSI) osteotomy guide for use in the orthopedic treatment of the stiff clubfoot.

MATERIAL AND METHODS

There were 20 patients (25 feet) with stiff clubfoot admitted from December 2018 to June 2022, including 13 males (16 feet) and 7 females (9 feet), aged 24-52 years, mean 40.15 years; 8 left feet, 7 right feet, 5 bipedal. All patients underwent triple arthrodesis and were divided into 10 cases (12 feet) in the PSI group (n = 12) and 10 cases (13 feet) in the conventional surgery group (n = 13) according to the surgical approach. The duration of surgery and the number of radiation exposures were recorded in all cases, and the American Orthopedic Foot and Ankle Society (AOFAS), and International Congenital Clubfoot Study Group (ICFSG) scoring systems were applied postoperatively to assess the effect of corrective treatment. All measurement data were expressed as mean ± standard deviation, and differences between groups were determined by Student's t test. All count data between the two groups were compared using the chi-square test or Fisher's exact test analysis.

RESULTS

All 20 patients (25 feet) were followed up for 1 year. No major complications related to osteotomy, such as overcorrection, incomplete correction, or bone nonunion, were observed in the PSI and conventional surgery groups at the final follow-up, and the PSI group had the advantage of shorter operative time (P < 0.01), less radiation exposure (P < 0.01), and higher excellent rate compared with the conventional surgery group. The AOFAS score (P > 0.05) and ICFSG score (P > 0.05) at the last follow-up were not statistically significant in both groups, but the excellent rate at the last follow-up was 91.7% in the PSI group which was significantly higher than that of the conventional surgery group at 76.9%.

CONCLUSIONS

The utilization of 3D printing-assisted PSI osteotomy guide in orthopedic surgery for stiff clubfoot offers a safe and effective surgical tool for triple joint fusion treatment. This technology simplifies surgical procedures, minimizes intraoperative radiation exposures, reduces surgical time, and enables precise and personalized treatment.

A Novel Orthoplastic Reconstruction of Relapsed Clubfoot With Total Ankle Arthroplasty

Congenital clubfoot is addressed in infancy and rarely persists into adulthood. Ankle arthroplasty is an increasingly popular surgical intervention for patients with ankle arthritis since it allows a natural ankle range of motion and completely replaces a degenerative hindfoot. Here, we describe the first successful total ankle arthroplasty (TAA) for a patient with previously treated congenital clubfoot that reverted later in life. To address the patient's poor soft-tissue integument and reduce the likelihood of post-surgical complications, a perioperative latissimus muscle-free flap was performed. This two-staged, novel orthoplastic intervention addressed our patient's ankle issues and appears to be a viable option for clubfoot patients.