Ponseti Casting and Achilles Release Versus Classic Casting and Soft Tissue Releases for the Initial Treatment of Arthrogrypotic Clubfeet.
BACKGROUND
Wide soft tissue releases (STRs) are considered the classic operative approach to the arthrogrypotic clubfoot, but recently the Ponseti method with Achilles tenotomy has been proposed as the initial treatment for those deformities.


METHODS
A retrospective comparison of clinical results and treatment course after 5 to 10 years of follow-up (FU) in arthrogrypotic clubfeet treated initially with STRs or the Ponseti method was performed. Mann-Whitney and χ(2) tests were used to assess significant differences between variables.


RESULTS
Twenty-nine children with 57 arthrogrypotic clubfeet were divided into 2 subgroups: the Ponseti subgroup (9 children, 18 clubfeet, mean FU: 7.3 years), which achieved 14 good and 4 satisfactory final results. The complication rate was 5.5%. Reoperation rate was 1.2 per foot, with 90.9% being STRs and 9.1% wedge osteotomies. The mean total anesthesia and surgery time equaled 116.6 and 77.4 minutes, respectively. The interval between primary and redo surgery was 27.3 months on average. The STR subgroup (20 children, 39 clubfeet, FU: 9.0 years on average) scored 20 good, 8 satisfactory, and 11 unsatisfactory results. Rate of complications was 23%. The mean total anesthesia and surgery times were 161.4 minutes and 102.8 minutes, respectively. The interval between the initial and secondary operations was 62.8 months on average. The revision rate was 1.0 per foot with 32.5% repeated STRs, while 67.5% were talectomies, osteotomies, or salvage procedures.


CONCLUSIONS
The use of the Ponseti method as the initial treatment in arthrogrypotic clubfeet improved clinical outcomes, reduced invasiveness of revisions, and shortened overall time of anesthesia and surgery.


METHODS
Level III, retrospective comparative series.
Department of Orthopedics, University Children's Hospital of Krakow, Krakow, Poland kowalczyk012@gmail.com.
Bart
B
Kowalczyk
Department of Orthopedics, University Children's Hospital of Krakow, Krakow, Poland.
Jaroslaw
J
Felus
D000125:Achilles Tendon / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D061646:Operative Time; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D058971:Tenotomy; D055815:Young Adult
Ponseti method; arthrogryposis; clubfoot; results