Outcomes of Foot and Ankle Fixation Using Biointegrative Implants; a retrospective study

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: The use of biodegradable and biointegrative implants in orthopaedic surgery is increasing due to the elimination of the need for removal surgery and their comparable efficacy versus metal implants. The lack of need for removal surgery leads to lower complication rates and ultimately reduces healthcare costs for both patients and the healthcare system. However, more research on the outcomes of treatments with these implants, particularly patient-centered outcomes, is necessary. Due to the growing use of biodegradable and biointegrative implants in foot and ankle surgeries, in this study we aimed to evaluate mid-term patient-reported outcomes among patients who received biointegrative implants compared to standard metal implants in midfoot, hindfoot, and syndesmosis injuries. Methods: We conducted a retrospective case-control study of 178 patients who received either biointegrative or metal implants for midfoot, hindfoot, and ankle syndesmosis injuries. We compared Visual Analog Scale (VAS) for pain, Patient Reported Outcome Measurement System (PROMS) including Physical Function (PF), Pain interference (PIF) and Pain Intensity (PI), pre-operative, post-operative, 3 months, 6 months, and 12-month time periods. We reviewed radiology reports, radiographs, and Computed Tomography (CT) data at preoperative, post operative, 3-month, 6-month, 12-month and >12 months if available to ensure appropriate and sufficient fixation after the surgery and possible recurrence and joint widening in follow ups. Patients’ reports were evaluated for reoperation surgeries due to hardware failure. A repeated measures ANOVA test was performed using SPSS software. Results were presented as means ± standard deviation (SD). Results: Table 1 demonstrates results of VAS and PROM scores. Table 2 demonstrates results of diastasis measurements. There was no significant difference between either group regarding reoperation for the injury. Conclusion: The use of biointegrative screws results in a significant reduction in VAS pain scores and improvement in PROMS as early as the post-operative period (P <.001). The patient-reported outcomes including PI, PIF, and PF, as well as recurrence of the injury after treatment with biointegrative screws were comparable to metal screws. There was no difference between biointegrative and metal implants in their ability to preserve reduction.