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26-01-2012 | Surgery | Article

Metalwork removal in symptomatic patients following foot surgery recommended


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MedWire News: Patients who experience pain, function, or footwear-related problems following foot and ankle surgery for corrective osteotomy for hallux valgus or first metatarsophalangeal joint fusion should have any surgical metalwork removed, suggest study findings.

"For patients with metalwork in other parts of the foot and ankle, a careful evaluation is needed and patients should be adequately and thoroughly counseled prior to embarking on metalwork removal," say F Wadia and M Sundar, both from Royal Oldham Hospital in the UK.

The findings are of importance, given the increasing number of implant removal surgeries following elective foot and ankle surgery involving metal screws and plates. "Implant removal surgery is an additional burden not only on hospital resources and elective waiting lists, but also on the patient, especially if the indications for removal and subsequent benefits are not clearly defined," comment the researchers.

For the study, 27 patients, aged on average 60.2 years, who had undergone metalwork removal over a 4-year period were asked to complete a validated Visual Analogue Scale-Foot and Ankle (VAS-FA) questionnaire.

The interval between the initial surgery and implant removal was on average 18 months. Half of the patients had first ray surgery distal to and including the tarso-metatarsal joint and the other half had undergone midfoot, hindfoot, or ankle surgery.

Implant removal rates for first ray surgeries was 4.5% compared with 9.1% for patients with midfoot, hindfoot, and ankle surgery. No significant complications were associated with implant removal surgery, which was performed as a day case procedure.

Responses from 24 patients showed that mean overall VAS-FA scores were significantly better in patients who had first ray surgery compared with other procedures (78.0 vs 45.6). Furthermore, analysis of individual VAS-FA components revealed that first ray surgery patients scored significantly better in measures of pain (79.6 vs 46.6), function (79.5 vs 46.2), and other complaints (73.2 vs 43.3) compared with patients undergoing other surgery.

When the team asked patients whether they would recommend metal removal surgeries to their friends and family, 50% said they would. Of note, the majority of positive responders were patients who had undergone first ray surgeries.

Analysis of radiographs showed that five of the included 24 patients showed prominent metalwork. However, VAS-FA scores were on the lower side of the scale in four of these patients, suggesting that pain relief is not correlated with removal of prominent hardware.

The researchers say the findings should be interpreted with caution, given that pre-operative VAS-FA scores were not available, opening the possibility that first ray surgery patients had higher VAS-FA scores to begin with.

The findings are published in the journal The Foot.

By Ingrid Grasmo

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