Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
A calcaneal osteotomy is a common component of surgical management for various foot and ankle deformities. While this procedure has been demonstrated in the literature to provide safe and effective healing for this patient population, there has been a high rate of wound and infection complications observed due to the open nature of this procedure. Meanwhile, a minimally invasive (MIS) calcaneal osteotomy may accomplish the same hindfoot modification, while minimizing potential wound complications. Currently, literature remains limited regarding any direct comparison of outcomes between these two procedures. Accordingly, the current retrospective study pursued comparisons of postoperative outcomes and complication rates of patients undergoing an open vs. MIS calcaneal osteotomy.
Methods:
All patients who underwent an open or MIS calcaneal osteotomy between March 2021 and January 2024 at a single institution were identified and retrospectively reviewed. All procedures were performed by one of two fellowship-trained orthopaedic foot and ankle surgeons on patients > 18 years of age at the time of surgery.
Demographic information, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and complications were recorded for each patient at a minimum of 12 months follow-up. All continuous data were compared between cohorts by t-test and noncontinuous data were compared by Chi-squared analysis; all p < 0.05(*) were considered to be significant.
Results:
Thirty-seven patients who underwent open calcaneal osteotomy and 21 patients who underwent MIS calcaneal osteotomy met inclusion criteria. Patients in the open cohort were followed for a mean 24.6±10.5 (range, 12-47) months. Similarly, patients in the MIS cohort were followed for a mean 21.5±6.2 (range, 13-38) months. A significant improvement in PROMIS function (p < 0.001*, =0.003*), pain (p < 0.001*, < 0.001*), and mobility (p < 0.001*, =0.01*) scores were observed in the open and MIS cohorts, respectively. There was no significant difference in the union rate observed between cohorts (p=0.094). However, when comparing the rate of wound dehiscence between patients who received an open vs. MIS calcaneal osteotomy, the MIS cohort was found to have a significantly reduced rate (0% vs 24.3%, p=0.014*).
Conclusion:
While patient reported outcomes were significantly improved following surgery in both cohorts, data from the current study indicate the MIS procedure may allow for significantly lower wound complication rates in comparison to the open procedure. Additionally, both an open and MIS calcaneal osteotomy appear to offer safe and effective bone healing with no difference in union rates. Future expansion of the current study may allow for prospective or longer-term comparisons amongst these procedures. Nevertheless, this retrospective review may better guide surgeons’ when designing treatment of various foot and ankle deformities requiring correction.
