Assessing Complication Rates of Constructs Used in Midfoot Arthrodesis

Category: Midfoot/Forefoot; Other Introduction/Purpose: Midfoot arthrodesis is an essential procedure for restoring function and structural integrity to the foot for patients with end stage arthritis of the tarsometatarsal and naviculocuneiform joint complexes. There is little evidence regarding the optimal fixation construct for midfoot arthrodesis. In addition to fusion outcomes, complications such as revision procedures, infection, and deep vein thrombosis (DVT) are essential considerations that require analysis. The purpose of this study is to evaluate the rate of revision surgery for nonunion, infection requiring irrigation and debridement (I&D), symptomatic hardware removal, surgical site infections, and deep venous thrombosis (DVT) between the various constructs used in midfoot arthrodesis to better aid surgeon selection and preoperative decision making. Methods: Patients who underwent midfoot arthrodesis between 2010-2023 at a single institution were included in final analysis. Qualifying procedures included fusion of any of the tarsometatarsal (TMT) joints, the Lisfranc articulation, or the naviculocuneiform (NC) joint. Complications were classified as revision surgery for nonunion, infection, or other revision procedure (e.g. symptomatic hardware removal). Additional complication categories included surgical site infection and postoperative DVTs. Rates of each complication were compared across constructs used in the arthrodesis procedures and the joints being fused. P-values were calculated using Pearson’s chi-squared test. Statistical analyses were carried out using Python 3.11.7 and Microsoft Excel. Results: In total, 150 patients with arthrodesis performed across 195 joints were followed for an average of 2 years post-operatively as part of this study. Arthrodesis constructs using combination staples and screws were found to have a significantly higher total revision rate (27.2%) than those using only staples (5.4%, p = 0.048) or only screws (5.3%, p = 0.043). This relationship held true when looking specifically at revision surgery to address symptomatic hardware, with combination staple and screw constructs demonstrating a higher rate (22.7%) than either staples (0%, p = 0.011) or screws (2.6%, p = 0.040) alone. Additionally, revisions due to infection, regardless of construct, occurred at a higher rate in the 2nd TMT joint (3.9%) than in the NC joint (0%, p = 0.038). Conclusion: The combination of staples and screws for midfoot arthrodesis results in higher complication rates, particularly revision due to symptomatic hardware, than screws or staples alone. Increased hardware in the relatively small margins of the midfoot are not well tolerated and increase risk of reoperation.