FACTORS ASSOCIATED WITH UNPLANNED SURGERY FOLLOWING TARSAL COALITION RESECTION: A MULTICENTRE REVIEW

Surgical excision of symptomatic tarsal coalitions is considered when nonoperative treatments fail to alleviate symptoms. Reasons and rates of revision surgery are rarely reported. This study aims to determine rates and causes for revision surgery for pediatric tarsal coalitions. This is a retrospective multicenter study involving patients aged ≤18 years at time of primary surgery for talocalcaneal coalition (TCC) or calcaneonavicular coalition (CNC) across 10 academic centers between 2001 and 2023 with ≥ 1-year follow-up. Medical records were reviewed to collect patient demographics, imaging data, coalition characteristics, management details, patient-reported outcomes, and documentation of pain. Statistical analysis included ANOVA and Chi-Squared tests, with significance set at 0.05. Two hundred and five patients met inclusion criteria, with 108 (52.7%) females, 78 (38%) with bilateral coalitions, and a mean age at surgery of 11.6 years. Only 7 (4.3%) had multiple coalitions in one foot, and 154 (77.4%) underwent nonoperative treatment before surgery. Follow-up was 33.92 months for CNC and 42.54 months for TCC patients (P=0.022). There were 132 CNC and 63 (52.1%) had concurrent deformities. Coalition resection was performed in 122 (92.4%) feet and deformity correction in 17 (12.9%). Fat was the interposition material in 63 (51.6%) cases. The cohort included 106 TCC, and of the 71 patients with documented coalition location, the middle facet was most common 65 (91.5%). 91 (85.8%) underwent coalition resection and 25 (23.6%) had concurrent deformity correction. Fat was the interposition material in 65 (67.7%) patients. Revision surgery was required in 26 (21.2%) CNC cases and 15 (16.7%) TCC cases (P=0.262). Coalition recurrence was the primary reason for revision in 11 (45.8%) CNC and 5 (29.4%) TCC feet (P=0.200), and repeat excision was performed in 10 (38.5%) for CNC and 4 (26.7%) TCC feet. Five TCC patients had persistent deformity with 4 requiring deformity correction. Subsequent fusion was performed in 3 CNC and 3 TCC patients. Pain was reported by 59 (44.7%) CNC and 50 (47.2%) TCC patients at latest follow-up (P=0.401). Almost one in five patients required revision surgery with repeat resection being the most common reason followed by deformity correction. Families should be educated about the potential need for revision surgery after primary tarsal coalition resection. This is one of the largest series of tarsal coalitions. A better understanding of risk factors for revision surgery is needed to establish optimal surgical indications. This will be addressed in subsequent analyses of this dataset.