Wedge Tarsectomy using Patient Specific Instrumentation in a Tertiary Foot and Ankle Unit

Yahya Ibrahim, Panos Poulious, Shelain Patel, Nicholas Cullen, Matthew Welck, Karan Malhotra

Introduction: Bony correction in complex cavovarus deformities is challenging. To correct deformity at the CORA a multiplanar wedge tarsectomy (WT) may be required. We examine our results of WT using patient-specific instrumentation (PSI).

Method: This single-centre, prospective cohort study evaluated non-correctable cavovarus feet undergoing PSI-guided WT. Accuracy of PSI guides/plans, surgical duration and adjunctive procedures were recorded. Pre- and postoperative weight-bearing CT (WBCT) measurements and PROMs (at 1 year) were compared. Data was normally distributed and analysed with paired t-tests and Pearson correlation.

Results: 11 patients had tri-planar deformities with a CORA at the Chopart or navicular-cuneiform joint. Mean surgical time was 135 minutes. Planned correction was achieved in all cases. Two cases required minor adjustments to initial osteotomy. Nine patients required adjunctive procedures. Postoperative radiological measurements significantly improved including sagittal and axial Meary’s angle (p=0.039, p=0.010), talonavicular coverage (p<0.001) and coronal forefoot arch angle (p=0.001). All patients fused by 3 months. MOxFQ-Walking scores improved post-operatively, with a greater improvement with increasing correction of adduction (p=0.047, r=0.67). Improvements were noted in other PROMs but were not statistically significant. One patient had residual hindfoot varus and underwent subsequent calcaneal osteotomy. Two patients had delayed wound healing. One patient had transient neuropathic pain and one developed CRPS.

Conclusion: PSI-guided wedge tarsectomy is safe and achieves predictable multiplanar correction. Our unit’s experience has been excellent, with significant improvement in patients’ walking, particularly with larger deformity corrections.