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Satisfactory patient-based outcomes after surgical treatment for idiopathic clubfoot: includes surgeon's
Susan T Mahan1, Samantha A Spencer, James R Kasser
1*Department of Orthopaedics, Boston Children's Hospital †Department of Orthopaedics, Harvard Medical School, Boston, MA.
Insights
Surgical treatment for idiopathic clubfoot using posteromedial release yielded satisfactory patient outcomes comparable to healthy peers. This study evaluated outcomes using the Pediatric Outcomes Data Collection Instrument (PODCI).
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Clinical outcomes research
Background:
- Idiopathic clubfoot treatment has evolved from surgery to the Ponseti technique.
- Previous surgical outcomes for clubfoot have been variable and often discouraging.
- This study examines long-term outcomes of a specific surgical approach.
Purpose of the Study:
- To evaluate the patient-based outcomes of idiopathic clubfoot treated with a la carte posteromedial and lateral releases.
- To assess outcomes using the Pediatric Outcomes Data Collection Instrument (PODCI) with a minimum of 2-year follow-up.
- To compare surgical outcomes to healthy controls.
Main Methods:
- Retrospective review of 148 patients with idiopathic clubfoot treated by a single surgeon over 15 years.
- Mailed PODCI questionnaires were sent, with 74 complete responses (50% response rate).
- Patient-reported outcomes were compared to published data for healthy controls using t-tests.
Main Results:
- Parent-reported PODCI data showed no significant differences compared to healthy controls across all 5 categories.
- Adolescent self-reported PODCI data revealed no differences in 4 of 5 categories.
- A significant difference was found in the Happiness Scale (P = 0.0031) in adolescent self-reports.
Conclusions:
- Judicious posteromedial release surgery for idiopathic clubfoot can lead to patient-based outcomes not different from healthy peers.
- These satisfactory results were observed primarily during the era when surgery was the standard treatment.
- While the Ponseti technique is now preferred, surgical management by experienced surgeons can still yield positive results.
Introduction:
Treatment of idiopathic clubfoot has shifted towards Ponseti technique, but previously surgical management was standard. Outcomes of surgery have varied, with many authors reporting discouraging results. Our purpose was to evaluate a single surgeon's series of children with idiopathic clubfoot treated with a la carte posteromedial and lateral releases using the Pediatric Outcomes Data Collection Instrument (PODCI) with a minimum of 2-year follow-up.
Methods:
A total of 148 patients with idiopathic clubfoot treated surgically by a single surgeon over 15 years were identified, and mailed PODCI questionnaires. Fifty percent of the patients were located and responded, resulting in 74 complete questionnaires. Median age at surgery was 10 months (range, 5.3 to 84.7 mo), male sex 53/74 (71.6%), bilateral surgery 31/74 (41.9%), and average follow-up of 9.7 years. PODCI responses were compared with previously published normal healthy controls using t test for each separate category. Included in the methods is the individual surgeon's operative technique.
Results:
In PODCIs where a parent reports for their child or adolescent, there was no difference between our data and the healthy controls in any of the 5 categories. In PODCI where an adolescent self-reports, there was no difference in 4 of 5 categories; significant difference was only found between our data (mean = 95.2; SD = 7.427) and normal controls (mean = 86.3; SD = 12.5) in Happiness Scale (P = 0.0031).
Discussion:
In this group of idiopathic clubfoot patients, treated with judicious posteromedial release by a single surgeon, primarily when surgery was treatment of choice for clubfoot, patient-based outcomes are not different from their normal healthy peers through childhood and adolescence. While Ponseti treatment has since become the treatment of choice for clubfoot, surgical treatment, in some hands, has led to satisfactory results.
Level Of Evidence:
Level III.
