Clinical Scorecard: Bioabsorbable Implants May Reduce Symptoms in Flatfoot Surgery
At a Glance
Category
Detail
Condition
Flexible flatfoot in pediatric and adolescent patients
Key Mechanisms
Subtalar arthroereisis using bioabsorbable or metallic implants to improve foot alignment
Target Population
Patients younger than 18 years undergoing flatfoot surgery
Care Setting
Orthopedic surgical care, primarily pediatric and adolescent foot surgery
Key Highlights
Both bioabsorbable and metallic implants improve clinical and radiographic outcomes in flexible flatfoot.
Bioabsorbable implants are associated with fewer implant-related symptoms and lower rates of nonroutine implant removal.
Evidence is limited and of low to moderate certainty, based on mostly retrospective studies with moderate risk of bias.
Guideline-Based Recommendations
Diagnosis
Diagnosis of flexible flatfoot should be confirmed clinically and radiographically prior to surgery.
Management
Subtalar arthroereisis is an effective surgical option for flexible flatfoot in pediatric and adolescent patients.
Implant selection (bioabsorbable vs metallic) should be individualized based on patient age, deformity severity, and surgeon experience.
Monitoring & Follow-up
Monitor for persistent sinus tarsi pain postoperatively, occurring in approximately 6-8% of cases depending on implant type.
Follow-up typically extends 2 to 3 years to assess implant-related symptoms and need for implant removal.
Risks
Metallic implants have higher odds of persistent sinus tarsi pain and nonroutine implant removal compared with bioabsorbable implants.
Potential heterogeneity in outcomes due to differences in implant design, surgical technique, and concomitant procedures.
Patient & Prescribing Data
Pediatric and adolescent patients undergoing subtalar arthroereisis for flexible flatfoot
Bioabsorbable implants may modestly reduce implant-related symptoms and revision rates compared to metallic implants, though overall radiographic and functional improvements are similar.
Clinical Best Practices
Individualize implant choice considering patient-specific factors and surgeon expertise.
Counsel patients and families about the potential for implant-related symptoms and the possibility of implant removal.
Use standardized functional outcome measures to assess postoperative improvement consistently.
Recognize the limited and low to moderate certainty evidence when discussing expected outcomes.
Patients with preoperative vitamin D deficiency had higher postoperative pain scores and opioid use after mastectomy, including more than triple the odds of moderate to severe pain within 24 hours of surgery.
