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Late Bone Marrow Edema Associated With Use of a Bioresorbable Polymer Suture Anchor in Foot and Ankle Surgery
Amanda I Zeng1, Philip G Colucci2, Constantine A Demetracopoulos1
1Orthopedic Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.
Background:
Bioresorbable orthopaedic implants have proliferated in recent years, including suture anchors, soft tissue scaffolds, and screws. At our institution, we anecdotally noticed late inflammatory-type reactions in the bone surrounding a particular bioresorbable polymer suture anchor. This bioresorbable anchor (BRA) uses ultrasonic technology to liquefy its tip, allowing interdigitation with surrounding cancellous bone. The polymer is designed to resorb around 2-3 years. In this study, we aimed to characterize complications associated with its use.
Methods:
A retrospective review was conducted of foot and ankle procedures using the BRA between 2018 and 2023, using a prospectively collected foot and ankle registry. Of the 62 patients who received at least 1 of these implants, 42 (68%) were female. Chart review was used to identify postoperative complications, particularly pain with bone marrow edema (BME) surrounding the anchor(s), as detected on magnetic resonance imaging (MRI). Patients were classified according to their primary diagnoses and level of physical activity. Patients with and without BME were compared to each other.
Results:
Twenty (32%, 95% CI 22%-45%) patients developed an inflammatory response at a mean of 27 months postoperatively. Four patients (20%) developed BME less than 1 year postoperatively, whereas the remaining 16 patients (80%) developed BME more than 2 years postoperatively. BME occurred more often in females (P = .047), and when used in the setting of trauma (P = .039). Symptoms resolved with nonoperative treatment in all but 3 cases (15%). No revision surgeries were performed.
Conclusion:
Nearly one third of the patients developed symptomatic bone marrow edema localized to the bioresorbable anchor. Female sex and ankle fracture were variables significantly associated with development of BME. Not all symptoms resolved with nonoperative treatment. These findings suggest caution should be exercised when using bioresorbable anchors.
Level Of Evidence:
Level IV, retrospective review.
