Complications of Calcaneal Osteotomy: Are They Equal Between Different Osteotomy Types?

Abstract

Category: Hindfoot; Other Introduction/Purpose: Calcaneal osteotomy is regularly performed as part of the surgical management of a number of conditions. Complication rates are thought to be low, however are these risks the same for different osteotomy types? In our institution a Lateralising Closing wedge osteotomy is performed for Cavus foot correction and Varus alignment with instability, whilst Lateral Column Lengthening Osteotomy and Medialising Displacement Calcaneal Osteotomy (MDCO) are performed for Pes Planus with and without forefoot abduction respectively. In severe Pes Planus deformities both may be utilised. The purpose of this study was to examine complication rates in each group. Methods: This is a retrospective case series of consecutive calcaneal osteotomies performed at our institution between January 2010 and December 2019. The primary outcome measures were healing of the osteotomy, metalwork removal and any other reported complications related to the calcaneal osteotomy including infection and wound problems. Patient demographics, associated procedures, indication for surgery, incision, and fixation method were also recorded. Results: There were 141 patients in the series. 77 patients underwent a lateralising osteotomy, 55 underwent MDCO and 12 Lateral column lengthening (LCL) with opening wedge osteotomy of the anterior process of the Calcaneus. Fixation was with cannulated screws, or specific purpose locking plates. Patients were followed up for a minimum of three months and discharged from follow-up once a satisfactory level of recovery was reached..One non-union was seen in each of the Lateralising, MDCO and LCL groups. Delayed union was seen in 3 lateralising osteotomies, and 1 MDCO. Metalwork irritation requiring surgery for metalwork removal was 6.5% (4 with screws, 1 plate), 9.1% (all screws) and 0% for Lateralising, MDCO and LCL osteotomies respectively. Wound problems or sural nerve irritation were noted in 11.7%, 3.6% and 8.3% of Lateralising and MDCO and LCL osteotomy respectively. 1 superficial infection was seen in the Lateralising osteotomy group Conclusion: One non-union was seen in all groups, with a trend for bone healing to be slower in those having lateralising procedures. Patients should be advised of this possibility if undergoing calcaneal osteotomy. Wound problems and sural nerve irritation were also more common with lateralising procedures. Metalwork removal due to hardware irritation was common (7% overall), and fixation method rather than osteotomy type appears to influence this with 9 cases following cannulated screws and 1 following lateral locking plate fixation. Screw fixation is associated with higher hardware removal rates.