Outcomes and Complications Associated with Lateral Column Lengthening Using Porous Titanium Wedges for Flexible Flatfoot Deformity Correction: A Systematic Review

Abstract

Numerous graft materials have been utilized and described to achieve deformity correction in lateral column lengthening procedures (LCL) including autograft, allograft, xenograft, and porous titanium wedges (PTW). PTWs offer a potentially advantageous substitute for traditional grafts. Evidence regarding outcomes and complications of these grafts remains limited. This systematic review aims to describe functional outcomes and complications associated with LCL using PTWs. A standard methodology for performing a systematic review was followed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. PubMed, Google Scholar, OVID, Embase, and Cochrane were searched. Publications with 1-year follow-up and LCLs performed with PTWs were included. Non-English articles and those that did not perform LCL with PTWs were excluded. 508 articles were identified. 7 studies met the inclusion criteria following our review. 246 LCLs (236 patients) using PTWs were reported. The Foot and Ankle Ability Measure Activities of Daily Living (FAAM-ADL) score measured at 80.45 (80.0-80.9) post-operatively. FAAM Sports subscale measured at 58.5 (50.0-66.9) postoperatively. VAS pain score decreased from 5.45 (5.0-5.9) pre-operatively to 2.43 (1.6-3.0) post-operatively. The total complication rate was found to be 15.2% (36/236). Major complications including non-union, reoperation, deep infection, and chronic regional pain syndrome (CRPS) were 2.1% (5/236). The evidence from this systematic review suggests that LCL with PTWs can be an effective and viable option for correcting flexible flatfoot deformities. The use of PTWs appears to offer comparable functional results and complication rates to traditional allograft or autograft wedges.