title: Subtalar Arthroereisis Implant Removal in Adults: A Prospective Study of 100 Patients.
abstract: Subtalar joint arthroereisis (STA) can be used in the management of adult acquired flatfoot deformity (AAFD), including posterior tibial tendon dysfunction. The procedure is quick and normally causes little morbidity; however, the implant used for STA often needs to be removed because of sinus tarsi pain. The present study evaluated the rate and risk factors for removal of the implant used for STA in adults treated for AAFD/posterior tibial tendon dysfunction, including patient age, implant size, and the use of endoscopic gastrocnemius recession. Patients undergoing STA for adult acquired flatfoot were prospectively studied from 1996 to 2012. The inclusion criteria were an arthroereisis procedure for AAFD/posterior tibial tendon dysfunction, age >18 years, and a follow-up period of ≥2 years. The exclusion criteria were hindfoot arthritis, age <18 years, and a follow-up period of <2 years. A total of 100 patients (average age 53 years) underwent 104 STA procedures. The mean follow-up period was 6.5 (range 2 to 17) years. The overall incidence of implant removal was 22.1%. Patient age was not a risk factor for implant removal (p = .09). However, implant size was a factor for removal, with 11-mm implants removed significantly more frequently (p = .02). Endoscopic gastrocnemius recession did not exert any influence on the rate of implant removal (p = .19). After STA for AAFD, 22% of the implants were removed. No significant difference was found in the incidence of removal according to patient age or endoscopic gastrocnemius recession. However, a significant difference was found for implant size, with 11-mm implants explanted most frequently.
authors.affiliation: Department of Sports Medicine, Palo Alto Medical Foundation Group, Palo Alto, CA. Electronic address: heysax@aol.com.
authors.forename: Amol
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Department of Orthopaedic and Traumatology, University of Rome "Tor Vergata" School of Medicine, Rome, Italy.
authors.forename: Alessio Giai
authors.initials: AG
authors.lastname: Via
authors.affiliation: Professor, Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Mile End Hospital, London, UK; Professor, Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.affiliation: Third Year Resident, Podiatric Medicine and Surgery Residency Program, Department of Veterans Affairs Healthcare System, Palo Alto, CA.
authors.forename: Haywan
authors.initials: H
authors.lastname: Chiu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005413:Flatfoot / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010146:Pain / Q000209:etiology*; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000009:adverse effects*; D011475:Prosthesis Failure; D012086:Reoperation; D013380:Subtalar Joint / Q000601:surgery*; D055815:Young Adult
keywords: adult acquired flatfoot; ankle equinus; posterior tibial dysfunction; subtalar arthroereisis