A Case Series Evaluating Complications of Foot and Ankle Surgeries in Patients with Neuromuscular Disease

Abstract

Category: Other Introduction/Purpose: Patients with neuromuscular diseases such as cerebral palsy often deal with foot and ankle deformity or dysfunction. These same patients are also living longer due to advances in medicine. This creates a significant population of patients that could benefit from corrective surgery. However, some surgeons are hesitant to offer surgery due to concern for complications. There is little in the literature to describe outcomes for foot and ankle surgery in this patient population. This study will provide information regarding complications associated with foot and ankle surgery in patients with neuromuscular disease. The primary study outcome was to describe the overall complication rates associated with foot and ankle surgery in patients with neuromuscular disease. Methods: The charts of neuromuscular patients undergoing foot and ankle surgery by the senior author from March 2010 to March 2020 were reviewed. Charts were analyzed for demographic data, medical history and diagnoses, and surgical treatment information. Index procedures were evaluated for any complications. For the purpose of our study, we identify an index procedure as the first surgical episode on a given extremity for a unique foot and ankle pathology. Charts were then analyzed for the presence or absence of a postoperative complication. We defined complication as the post-operative occurrence of wound dehiscence, superficial or deep infection, nonunion or delayed union, or a post-operative medical complication. Results: 46 patients with 57 extremities, and 66 index surgeries were identified. 20% of the index surgeries (13 of 66) had one or more complications. Patients ranged in age from 12 to 70 year of age with a mean of 33.8 years. Females comprised 61% of the patient cohort. CP was the most common neuromuscular diagnosis at 52% (24 of 46 patients). The number of procedures performed during a patient's index surgery ranged from 1 to 15 (mean: 3.4). Achilles lengthening was the most common procedure, performed in 44% of patients. A summary of complications can be seen in the attached table, along with patient demographic data. Conclusion: We identified an overall complication rate of 20%, with 12% wound complication rate and 7% nonunion rate. These rates were similar to previous literature on elective foot and ankle surgery. Our infection rate of 9% is higher than previously reported in the general foot and ankle literature. Of note, 31% of the total complications were in patients with spina bifida even though they made up just 9% of the population. We conclude that foot care of adult patients with neuromuscular disease s should be aware of the unique surgical challenges that this population faces.