Hello, my name is Vince Vecchietta. I'm a current fellow at the Orthopedic Foot and Ankle Center in Columbus, Ohio, and I'm here speaking to you today about calcaneal osteotomies and the prevention of deformity-driven subtalar joint arthritis. Our disclosures can be accessed via the conference portal. So the reason we chose to pursue this study was due to the lack of literature looking at calcaneal osteotomies and their association with long-term subtalar joint osteoarthritis. Additionally, we wanted to look at the varying rates of hardware removal within calcaneal osteotomies, and lastly, we wanted to evaluate the viability of the Kellgren-Lawrence scale for grading of subtalar joint osteoarthritis. The primary purpose of our study was to evaluate the protective nature of calcaneal osteotomies and the advancement of subtalar joint osteoarthritis. Secondarily, we wanted to evaluate hardware removal rates as well as the reliability of the Kellgren-Lawrence scale in subtalar joint osteoarthritis. Our hypothesis was that calcaneal osteotomies would be somewhat protective against subtalar joint osteoarthritis. We believe that the posterior calcaneal osteotomies would be most protective, whereas the lateral column lengthening procedures would be to a lesser degree protective, secondary to the anatomic location and joint pressure changes with this osteotomy. So we performed a retrospective review of 255 consecutive patients using the CPT for calcaneal osteotomy for patient identification. Deformity driven for the purpose of our research was defined as calcaneal osteotomies performed to address deformity with no evidence of prior trauma in the patient's clinical chart. Here's our inclusion and exclusion criteria, note the minimum three-year clinical and radiographic follow-up for inclusion into this study. Radiographic evaluation using the Kellgren-Lawrence grading system was performed on lateral foot radiographs preoperatively as well as at the most recent follow-up visit. Our statistical analysis consisted of an interclass correlation coefficient and a one-way ANOVA test. This is the Kellgren-Lawrence grading scale we utilized. Ultimately, we had 55 calcaneal osteotomies in 44 patients, 33 were isolated, and 11 were double osteotomies. We had 35 females and 9 males, and the incidence of the respective osteotomy types can be seen below. We had a mean follow-up of 52 months. One of the 55 surgical extremities, or 2%, required subsequent subtalar joint arthrodesis. This was performed at 46 months following the index procedure, which was a lateral column lengthening procedure. There were no statistically significant differences between the osteotomy groups. Ultimately, our statistics demonstrated that our original hypothesis regarding the lateral column lengthening was somewhat true in the fact that the lateral column lengthening showed a higher propensity towards the formation of subtalar joint osteoarthritis when compared to the posterior calcaneal osteotomies. In regards to the Kellgren-Lawrence scale and the interclass correlation coefficient, preoperatively we showed moderate reliability between observers, and postoperatively there was poor reliability between observers. We had a hardware removal rate overall of 28%, and the respective hardware removal rates for each osteotomy can be seen below. We further broke down our posterior calcaneal osteotomy hardware removal rates into those receiving headed versus headless screws, and we found that 100% of the posterior calcaneal osteotomy hardware removal cases occurred in patients with headed screws. Lateral column lengthening fixation varied amongst the subjects, and we had one incidence of hardware removal, which was in a lateral locking plate. Ultimately, calcaneal osteotomies were successful in the prevention of deformity-driven subtalar joint osteoarthritis in the intermediate time frame. We had a 28% hardware removal rate following calcaneal osteotomy, which is consistent with the previous research, and the Kellgren-Lawrence grading system was not reliably consistent between observers. Some shortcomings of our study. There is certainly an inherent bias associated with the retrospective review. I believe the most important shortcoming is the intermediate-term follow-up. This is a study looking at arthritis, and certainly a long-term study would be more appropriate for evaluating arthritis. Secondarily, we had a small patient population, and lastly, this was a radiographic review. Certainly utilizing a weight-bearing CT would be beneficial in evaluating the arthritic joints of these patients. Thank you.

calcaneal osteotomies

subtalar joint arthritis

hardware removal

Kellgren-Lawrence scale

retrospective review