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Factors predicting the outcome of primary clubfoot surgery
Peter A Templeton1, Mark J Flowers, Kevin H Latz
1Hospital for Sick Children, Toronto, ON.
Insights
Further surgery for idiopathic clubfoot was needed in 19% of cases. Optimal functional outcomes were observed when surgery occurred closer to 12 months of age, suggesting a delay in the second half of infancy.
Area of Science:
- Pediatric Orthopedics
- Surgical Outcomes
- Idiopathic Clubfoot Treatment
Background:
- Assessing outcomes of primary clubfoot surgery is crucial for optimizing pediatric orthopedic care.
- Understanding factors influencing further surgical intervention and functional results is essential.
Purpose of the Study:
- To determine the rate of revision surgery after primary idiopathic clubfoot correction.
- To evaluate functional outcomes and identify associated factors in children undergoing clubfoot surgery.
- To provide evidence-based recommendations for the optimal timing of surgical intervention.
Main Methods:
- Retrospective cohort study of children under 2 years old undergoing idiopathic clubfoot surgery.
- Review of 126 patient charts from a tertiary care pediatric hospital.
- Functional Rating System (FRS) scores used to assess outcomes, with a mean follow-up of 80.6 months.
Main Results:
- 19% of patients required further surgery.
- The mean Functional Rating System (FRS) score was 79.
- Increased age at surgery correlated with improved FRS scores (1.9 points per month increase).
- The presurgical talocalcaneal index was the only factor associated with the need for further surgery.
Conclusions:
- A 19% rate of further surgery highlights the need for careful surgical planning.
- Performing surgery closer to 12 months of age is associated with superior functional results.
- Surgical intervention in the second 6 months of infancy may yield better long-term outcomes for idiopathic clubfoot.
Background:
We aimed to determine the rate of further surgery, the functional outcome and the factors associated with outcome after primary clubfoot surgery.
Method:
We conducted a retrospective study of a cohort of all children who were less than 2 years of age at the time of surgery for idiopathic clubfoot deformity at the Hospital for Sick Children, Toronto, Ont., a tertiary care pediatric hospital. Of the 91 families who could be contacted, 63 agreed to return. The children's charts were reviewed, and their feet were given a Functional Rating System (FRS) score.
Results:
Of the original operated population (n = 126), 75% were male and 41% had bilateral clubfoot. The average age at the time of surgery was 8 months, and the mean follow-up was 80.6 months. Further surgery was performed in 19% of cases. The mean FRS outcome score was 79. On average, the FRS score increased by 1.9 points as age at the time of surgery increased by 1 month. Only the presurgical talocalcaneal index was associated with the need for further surgery.
Conclusion:
The need for further surgery was 19% overall. Children who had surgery closer to 12 months of age had better functional results. Therefore, surgery should probably be performed in the second, rather than the first, 6 months of life.