Simultaneous vs Separate Subtalar Arthrodesis-Calcaneal Osteotomy: A Retrospective Study

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Some studies advocate for performing subtalar arthrodesis and calcaneal osteotomy simultaneously in cases of substantial deformity, arthritic changes, or instability as seen in severe adult-acquired flatfoot deformity. More commonly, one procedure is performed at a later time secondary to the development of arthritis or continued/worsening deformity. While concurrent surgery has been described in the literature, there is increased concern for nonunion and there exists a lack of studies reporting clinical outcomes. Furthermore, comparative healing rates after concurrent subtalar arthrodesis/calcaneal osteotomy as opposed to staged procedures is unknown. This study seeks to fill that gap by providing comparative clinical outcomes. Methods: A retrospective chart review was conducted on 28 patients who underwent subtalar arthrodesis and calcaneal osteotomy. Of these patients, 19 (67.9%) underwent simultaneous procedures while 9 (32.1%) received the same procedures at two different time points. Demographics, complication rates, visual Analog Scale (VAS) scores, recovery time, and comorbidities were among the factors evaluated. Comparisons were conducted using Mann - Whitney U Tests and Fisher’s Exact Tests due to limited sample size and data characteristics. P values < 0.05 were considered to be statistically significant. Results: There were no statistically significant differences found between the groups for the variables examined. Complication rates, including surgical site infections, dehiscence, deep vein thromboses, and sural nerve injury were generally low with no statistical differences noted. While patients who received simultaneous procedures had a lower rate of revision surgery (14.29% vs 33.33%) for complications and lower rates of non-union (5.56% vs 11.11%) these did not reach statistically significance and were limited by the small study cohort. Conclusion: Our results demonstrate that there are no significant differences in complication rates when comparing a cohort of patients who underwent simultaneous subtalar arthrodesis/calcaneal osteotomy to those that underwent the same procedures at different time points. While not reaching statistical significance, patients who underwent simultaneous procedures had lower rates of revision surgery, nonunion with shorter time to weightbearing. Although limited by small sample size, this study serves as an initial exploration into the potential impact of concurrent procedures. Follow up studies combining multi-institutional databases can increase cohort size, study power and improve generalizability of findings.