Hannes Kubo1, Carina Lipp2, Martin Hufeland3, Martin Ruppert4, Bettina Westhoff5, Ruediger Krauspe6, Hakan Pilge7. 1. University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany. Electronic address: hannes.kubo@med.uni-duesseldorf.de. 2. University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany. Electronic address: carina.lipp@uni-duesseldorf.de. 3. University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany. Electronic address: martin.hufeland@med.uni-duesseldorf.de. 4. University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany. Electronic address: martin.Ruppert@mutterhaus.de. 5. University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany. Electronic address: westhoff@med.uni-duesseldorf.de. 6. University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany. Electronic address: krauspe@med.uni-duesseldorf.de. 7. University of Düsseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Düsseldorf, Germany. Electronic address: hakanpilge@web.de.
Abstract
OBJECTIVES: The subtalar screw arthroereisis (SSA) is a treatment option for painful pediatric flexible flatfeet (PFF). Hence, the optimal time point for a SSA is discussed controversially. Therefore the present study evaluates the influence of the patient's age at surgery on the radiological outcome to provide further evidence in this matter. METHODS: From 08/2007 to 12/2015 50 patients with 95 PFF were included. Inclusion criteria were: 1) Patients with PFF under or equal 15 years of age, 2) treatment with SSA and 3) presence of pre-op, post-op and follow up (FU) routine biplane radiographs. A subdivision was made into group A: 5-8 years, group B: 9-12 years and group C: 13-15 years. The radiographs were analyzed for: 1) calcaneal-pitch (CP), 2) lateral talocalcaneal angle (lat. TCA), 3) a.p. talocalcaneal angle (a.p. TCA, kite angle) and 4) navicular-cuboidal-index (NCI) and meary angle. RESULTS: Our study showed the best deformity correction when surgery was conducted between 9 and 12 years of age (group B), with significant improvement in all measured parameters without secondary deterioration during FU. In group A, the SSA show inferior results with poorer long-term success with only an improvement in the a.p. TCA. Group C showed mixed results. While CP and NCI improved, the lat. TCA deteriorated in FU. In conclusion, the ideal age for surgical intervention by SSA is between 9 and 12 years. Surgery before the age of 8 years did not show long-term success and delayed treatment at the age of 13-15 was only partially successful with deterioration during FU period. LEVEL OF EVIDENCE: IV.
OBJECTIVES: The subtalar screw arthroereisis (SSA) is a treatment option for painful pediatric flexible flatfeet (PFF). Hence, the optimal time point for a SSA is discussed controversially. Therefore the present study evaluates the influence of the patient's age at surgery on the radiological outcome to provide further evidence in this matter. METHODS: From 08/2007 to 12/2015 50 patients with 95 PFF were included. Inclusion criteria were: 1) Patients with PFF under or equal 15 years of age, 2) treatment with SSA and 3) presence of pre-op, post-op and follow up (FU) routine biplane radiographs. A subdivision was made into group A: 5-8 years, group B: 9-12 years and group C: 13-15 years. The radiographs were analyzed for: 1) calcaneal-pitch (CP), 2) lateral talocalcaneal angle (lat. TCA), 3) a.p. talocalcaneal angle (a.p. TCA, kite angle) and 4) navicular-cuboidal-index (NCI) and meary angle. RESULTS: Our study showed the best deformity correction when surgery was conducted between 9 and 12 years of age (group B), with significant improvement in all measured parameters without secondary deterioration during FU. In group A, the SSA show inferior results with poorer long-term success with only an improvement in the a.p. TCA. Group C showed mixed results. While CP and NCI improved, the lat. TCA deteriorated in FU. In conclusion, the ideal age for surgical intervention by SSA is between 9 and 12 years. Surgery before the age of 8 years did not show long-term success and delayed treatment at the age of 13-15 was only partially successful with deterioration during FU period. LEVEL OF EVIDENCE: IV.