Multi-staged Versus Single-staged Reconstruction for Progressive Collapsing Foot Deformity (PCFD): A Retrospective Cohort Study of Complications and Cost

Background Surgical reconstruction of progressive collapsing foot deformity (PCFD) is generally performed using a single-staged (SS) approach. However, a multi-staged (MS) approach may be used and has not been previously described or evaluated. Questions: 1. Are there any differences in complication rates and subsequent operation rates between SS and MS PCFD reconstruction? 2. How do the costs of SS PCFD reconstruction compare to MS PCFD reconstruction? Methods A retrospective cohort study of SS and MS PCFD reconstruction was performed, with treatment allocation determined by the treating surgeon. Rates of major complications, subsequent operations, and costs of operating time and hospital admissions were compared. Results Seventy-four feet with SS and 63 feet with MS reconstruction were included. Higher major complication rates were noted in SS (16%) compared with MS reconstruction (2%) ( P = .02), with no significant difference in subsequent operation rate ( P = .05). Total operating room and hospital admission costs were higher in SS ($20 868) compared with MS ($14 900) ( P = .01). Conclusions This study reports outcomes of MS approach for PCFD reconstruction. In this cohort, MS reconstruction was associated with lower wound complication risks and costs compared with a traditional SS approach. Future studies evaluating patient-reported outcomes are warranted to further optimize surgical management of PCFD. Level of Evidence 3