Calcaneocuboid Distraction Arthrodesis With Synthetic Bone Grafts: Preliminary Results of an Innovative Bone Grafting Procedure in 13 Patients

ABSTRACT Calcaneocuboid distraction arthrodesis (CCDA) is regarded as an effective method for reconstructing adult‐acquired flatfoot deformity. In the present study, we present our experience with newly developed rigid &bgr;‐tricalcium phosphate wedges to treat CCDA to better understand the outcomes of this synthetic bone grafting procedure. A total of 13 feet in 13 patients underwent CCDA with synthetic bone grafts. One male (7.69%) and 12 females (92.31%), with a mean age of 65.07 ± 11.83 (range 36 to 77) years, were followed up for a mean duration of 32.76 ± 12.81 (range 18 to 55) months. Successful graft union was postoperatively obtained in 12 of the 13 feet (92.31%). The mean preoperative visual analog scale and American Orthopaedic Foot and Ankle Society scale score were 7.97 ± 1.52 (range 5.4 to 10) and 54.46 ± 14.72 (range 18 to 75), respectively. These scores improved to 1.52 ± 1.78 (range 0 to 6.2) and 85.46 ± 13.38 (range 50 to 97) postoperatively (p = .001 for both comparisons). On radiographic analysis, the talonavicular coverage angle, first metatarsal talar angle, calcaneal pitch, and heel alignment angle had significantly improved (p = .001, p = .028, p = .006, and p = .001, respectively). The use of bone graft substitutes in CCDA is a viable treatment option for reconstructing flexible flatfoot deformity. Although good clinical and radiographic outcomes were obtained, our method is even more challenging than conventional methods and should be used with caution. Rigid locking fixation with a long period of protected weightbearing is highly recommended to attain uneventful bone healing.

[1]  Li Xiaojun,et al.  Supramalleolar Osteotomy With or Without Fibular Osteotomy for Varus Ankle Arthritis , 2016, Foot & ankle international.

[2]  Y. Kageyama,et al.  Treatment of Varus Ankle Osteoarthritis and Instability With a Novel Mortise-Plasty Osteotomy Procedure. , 2016, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[3]  Y. Kageyama,et al.  Isolated Fifth Metatarsocuboid Coalition: A Case Report. , 2015, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[4]  Christopher F. Hyer,et al.  Medial double arthrodesis with lateral column sparing and arthrodiastasis: a radiographic and medical record review. , 2015, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[5]  J. Cho,et al.  A cohort study of patients undergoing distal tibial osteotomy without fibular osteotomy for medial ankle arthritis with mortise widening. , 2015, The Journal of bone and joint surgery. American volume.

[6]  A. Catanzariti,et al.  Procedure selection for the flexible adult acquired flatfoot deformity. , 2014, Clinics in podiatric medicine and surgery.

[7]  K. Delank,et al.  Calcaneocuboid distraction arthrodesis with allogenic bone grafting for correction of pes planovalgus. , 2013, Acta orthopaedica Belgica.

[8]  D. Thordarson,et al.  Results of calcaneocuboid distraction arthrodesis. , 2012, Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons.

[9]  B. Hintermann,et al.  Treatment of Asymmetric Arthritis of the Ankle Joint with Supramalleolar Osteotomies , 2012, Foot & ankle international.

[10]  Eduardo Saiz,et al.  Direct ink writing of highly porous and strong glass scaffolds for load-bearing bone defects repair and regeneration. , 2011, Acta biomaterialia.

[11]  A. Woywodt,et al.  Organ donation, transplantation and religion. , 2011, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[12]  E. Bluman,et al.  Minimally Invasive Deltoid Ligament Reconstruction for Stage IV Flatfoot Deformity , 2011, Foot & ankle international.

[13]  A. Walling,et al.  The Use of Tricortical Autograft Versus Allograft in Lateral Column Lengthening for Adult Acquired Flatfoot Deformity: An Analysis of Union Rates and Complications , 2010, Foot & ankle international.

[14]  M. Mureau,et al.  Lateral column lengthening for acquired adult flatfoot deformity caused by posterior tibial tendon dysfunction stage II: a retrospective comparison of calcaneus osteotomy with calcaneocuboid distraction arthrodesis. , 2010, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[15]  A. Wymenga,et al.  Early full weight bearing is safe in open-wedge high tibial osteotomy , 2010, Acta orthopaedica.

[16]  R. Takeuchi,et al.  Medial opening wedge high tibial osteotomy with early full weight bearing. , 2009, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[17]  R. Takeuchi,et al.  Simultaneous bilateral opening-wedge high tibial osteotomy with early full weight-bearing exercise , 2008, Knee Surgery, Sports Traumatology, Arthroscopy.

[18]  M. Saito,et al.  Bone formation and resorption in patients after implantation of beta-tricalcium phosphate blocks with 60% and 75% porosity in opening-wedge high tibial osteotomy. , 2008, Journal of biomedical materials research. Part B, Applied biomaterials.

[19]  E. Bluman,et al.  Stage IV posterior tibial tendon rupture. , 2007, Foot and ankle clinics.

[20]  D. Bohay,et al.  Randomized Prospective Study Comparing Tri-Cortical Iliac Crest Autograft to Allograft in the Lateral Column Lengthening Component for Operative Correction of Adult Acquired Flatfoot Deformity , 2007, Foot & ankle international.

[21]  J. Louwerens,et al.  Adult acquired flexible flatfoot, treated by calcaneo-cuboid distraction arthrodesis, posterior tibial tendon augmentation, and percutaneous Achilles tendon lengthening: A prospective outcome study of 20 patients , 2006, Acta orthopaedica.

[22]  Stephen J. Miller,et al.  Diagnosis and treatment of adult flatfoot. , 2005, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[23]  E. G. Richardson,et al.  The Effect of Cigarette Smoking on Hindfoot Fusions , 2002, Foot & ankle international.

[24]  S. Conti,et al.  Osteolysis of Structural Autograft after Calcaneocuboid Distraction Arthrodesis for Stage II Posterior Tibial Tendon Dysfunction , 2002, Foot & ankle international.

[25]  S. Prada,et al.  Preliminary Results Comparing Two Methods of Lateral Column Lengthening , 2001, Foot & ankle international.

[26]  K. An,et al.  Calcaneocuboid Distraction Arthrodesis for Posterior Tibial Tendon Dysfunction and Flatfoot: A Cadaveric Study , 2000, Clinical orthopaedics and related research.

[27]  R. Mann.  Adult acquired flatfoot deformity. Treatment of dysfunction of the posterior tibial tendon. , 1997, The Journal of bone and joint surgery. American volume.

[28]  E. Elsinger,et al.  Coralline hydroxyapatite bone graft substitutes. , 1996, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[29]  C. Saltzman,et al.  The Hindfoot Alignment View , 1995, Foot & ankle international.

[30]  D. Sartoris,et al.  Coralline hydroxyapatite bone graft substitutes: radiographic evaluation. , 1992, The Journal of foot surgery.

[31]  K. A. Johnson,et al.  Tibialis posterior tendon dysfunction. , 1989, Clinical orthopaedics and related research.

[32]  D. Sartoris,et al.  Coralline hydroxyapatite bone graft substitutes: preliminary report of radiographic evaluation. , 1986, Radiology.