Relapse Rates in Patients with Clubfoot Treated Using the Ponseti Method Increase with Time: A Systematic Review

Area of Science:

• Orthopedics
• Pediatric Surgery
• Clinical Research

Background:

• The Ponseti method is standard for idiopathic clubfoot.
• Consensus is lacking on relapse rates and surgical intervention needs.
• Study objective: analyze the impact of follow-up duration on reported relapse and secondary surgery rates.

Purpose of the Study:

• To systematically review and quantify the influence of study follow-up duration on reported rates of idiopathic clubfoot relapse.
• To determine the correlation between follow-up length and the requirement for secondary corrective surgical procedures, both joint-sparing and joint-invasive.

Main Methods:

• Systematic literature search adhering to PRISMA guidelines.
• Extracted data included relapse definitions, relapse percentages, surgical procedure rates, and mean follow-up durations.
• Statistical analyses: Pearson correlations and logarithmic curve fit regressions to assess relationships between follow-up duration and outcomes.

Main Results:

• Forty-six studies were included, revealing four distinct definitions of relapse.
• Relapse rates varied widely (3.7%–67.3%).
• Mean follow-up duration strongly correlated with relapse rate (r=0.44) and joint-sparing surgery rates (r=0.59). Longer follow-up studies reported significantly higher rates of both outcomes.

Conclusions:

• Relapse can occur as late as age 10, yet few studies provide extended follow-up (≥8 years).
• Both relapse rates and the need for joint-sparing procedures increase with longer follow-up durations.
• Extended follow-up until skeletal maturity is recommended for accurate risk assessment and patient counseling regarding potential late relapses.