Metabolic bone abnormalities underlying nonunion in revision foot surgeries

Introduction Revision foot surgery has increased in recent decades with the increasing surgical procedures. Nonunion is common after arthrodesis and osteotomies. From an economic perspective, revision surgery can be associated with greater length of disability imposing an additional financial burden on healthcare facilities. Impaired bone metabolism is one of the key factors leading to the risk of nonunion and a revision surgery.

The aim of the study was to determine the impact of metabolism bone abnormalities on the incidence of nonunion in revision foot and ankle surgery.

Material and methods A prospective study with retrospective control was conducted to compare two groups of patients aged 45 to 70 years who required revision foot surgery. The retrospective control group (n = 36) consisted of patients who had no bone metabolism assessment prior to revision foot surgery. The prospective group (n = 42) consisted of patients who underwent bone metabolism assessment preoperatively and subsequent correction if needed. Revision surgery was produced in the hindfoot and midfoot due to failed arthrodesis of the corresponding joints. AP and lateral weight-bearing radiographs of the foot, the Salzmann view and a CT scan of the feet were produced preoperatively.

Results The mean period from the initial consultation to surgical treatment was longer in the prospective group than in controls: (16.0 ± 4.0) weeks and (8.0 ± 1.7) weeks, respectively. There were no significant differences in the mean period of consolidation/ankylosis measuring (10.0 ± 2.2) weeks in controls and (8.0 ± 1.5) weeks in the prospective group. A statistically significant difference was found in the frequency of non-unions between the two groups showing 14 % (n = 5) in controls and 2.4 % (n = 1) in the prospective group.

Discussion The findings demonstrated clinical effectiveness of a comprehensive approach to revision foot surgery including optimization of biological factors for bone union. Protocol for preoperative assessment and correction of bone metabolism can significantly improve outcomes of revision procedures reducing the risk of recurrent nonunions and the need for revisions.

Conclusion The time from initial consultation to revision surgery was longer in the prospective group of patients with no statistically significant differences in the time to bone consolidation. The nonunion rate was higher in the control group with no diagnosis and correction of bone metabolism diagnostics performed, highlighting the importance in reducing the rate of revision foot and ankle surgeries.

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