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Risk Factors for Complications Associated With Minimally Invasive Medial Displacement Calcaneal Osteotomy
Michelle M Coleman1, Mostafa M Abousayed1, John M Thompson1
1Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA.
Background:
Few studies have reported the outcomes following minimally invasive medial displacement calcaneal osteotomy (MDCO) for correction of pes planovalgus deformities.
Methods:
Charts were retrospectively reviewed for consecutive patients who underwent minimally invasive MDCO procedures by a single surgeon from 2013 to 2019 with more than 3 months of follow-up. A total of 160 consecutive patients who underwent 189 minimally invasive MDCO procedures were included in the study. Median follow-up was 12 months (interquartile range, 7-25 months).
Results:
Osteotomy healing complications were present in 7% of cases during the 6-year study period. A 12-month case cluster of osteotomy healing complications was observed. Healing complication rates were 28% during the cluster and 0.7% outside of the cluster. No definitive cause was found for the case cluster, although heat osteonecrosis from the burr was suspected to be involved. Osteotomy healing complications were significantly associated with higher American Society of Anesthesiologists (ASA) classification, female sex, current tobacco use, and higher body mass index (BMI). Healing complications were not associated with osteotomy technique or fixation type. Other complications included wound dehiscence (3%), surgical site infection (2%), transient nerve symptoms (6%), and persistent nerve symptoms (2%). Nerve symptoms were significantly associated with an increased number of concomitant procedures.
Conclusion:
Patients with higher ASA classification, current tobacco use, and higher BMI were at higher risk for osteotomy healing complications after minimally invasive MDCO procedures. Patients were also more likely to develop nerve complications with more extensive surgical procedures.
Level Of Evidence:
Level IV, retrospective case series.
Insights
Minimally invasive medial displacement calcaneal osteotomy (MDCO) for pes planovalgus has risks. Higher ASA classification, tobacco use, and BMI increase healing complications, while more procedures raise nerve complication risks.
Area of Science:
- Orthopedic Surgery
- Foot and Ankle Surgery
Background:
- Pes planovalgus deformities require effective surgical correction.
- Minimally invasive medial displacement calcaneal osteotomy (MDCO) is an option for correction.
- Limited data exists on outcomes of minimally invasive MDCO.
Purpose of the Study:
- To evaluate the outcomes and complication rates of minimally invasive MDCO.
- To identify risk factors for osteotomy healing and nerve complications.
Main Methods:
- Retrospective review of 189 minimally invasive MDCO procedures in 160 patients (2013-2019).
- Median follow-up of 12 months.
- Analysis of osteotomy healing complications, wound complications, surgical site infections, and nerve symptoms.
Main Results:
- Overall osteotomy healing complication rate was 7%, with a 12-month cluster showing 28% vs. 0.7% outside the cluster.
- Risk factors for healing complications included higher American Society of Anesthesiologists (ASA) classification, female sex, tobacco use, and higher body mass index (BMI).
- Nerve symptoms were associated with an increased number of concomitant procedures.
Conclusions:
- Higher ASA classification, tobacco use, and BMI are risk factors for osteotomy healing complications after minimally invasive MDCO.
- Increased surgical complexity correlates with a higher likelihood of nerve complications.
