Outcomes of Nitinol Compression Staples in Tarsometatarsal Fusion

Abstract

Background: Tarsometatarsal (TMT) arthrodesis is commonly performed in the management of midfoot arthritis, trauma, or deformity. The purpose of this study was to collect aggregate data (demographic, surgical, and perioperative outcomes) on patients who previously had a TMT fusion with BME compression staples. Methods: Sixty-six patients underwent TMT fusion with BME compression staples. Outcomes included demographics, surgical information, the Veterans Rand VR-12 Health Survey, Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), Revised-Foot Function Index (FFI-R), Ankle Osteoarthritis Scale (AOS), patient satisfaction survey scores, radiographic fusion rate, level of pain reduction, and complications. Sixty-six patients (68 feet) were analyzed (59 females) with an average age of 64 years (range, 18-83). The mean latest follow-up was 35.9 (range, 6-56.6 months). Results: The average surgical time was 38.1±14.3 minutes (range, 11-75). All outcomes improved significantly ( P < .001) from preoperative to latest follow-up except for the VR-12 Mental and Physical score. The average time to fusion determined by radiographs was 8.4 weeks (range, 6.1-46.1 weeks). Wound complications were not seen. Indications for subsequent surgeries (26.5%, 18/68 feet) in this current study included pain (n = 14), broken staples, and nonunion (n = 3). Conclusions: The fusion rate in this study, 89.7%, was similar to values reported in the literature. The patient satisfaction score of 81.9 at latest follow-up is consistent with patient satisfaction for other methods of fusion. Level of Evidence: Level IV, retrospective case series.

Radioscapholunate Arthrodesis and Distal Radioulnar Joint Arthroplasty for Rheumatoid Wrist Arthritis: A Surgical Technique

“…31 In a retrospective clinical study, nitinol staples have demonstrated similar fusion rates and patient satisfaction after tarsometatarsal arthrodesis compared with other fixation options. 32 More recently, they have been used for hand surgical applications as well, such as treatment of scaphoid waist fracture nonunions. 33 In preoperative counseling with patients who have RA and desire this procedure to retain as much wrist motion as possible and avoid a TWA, we do discuss the importance of the preservation of the midcarpal joints.…”

Two Orthogonal Nitinol Staples and Combined Nitinol Staple-Screw Constructs for a First Metatarsophalangeal Joint Arthrodesis: A Biomechanical Cadaver Study

“…Nitinol staples also have the advantage of compressing fusion surfaces without crossing the fusion surface and thereby maximizing the total contact area. 1,13,19 Additionally, these implants can be inserted quickly 7 and are smaller than commonly used dorsal compression plates, which reduces operative time and the frequency of symptomatic implants. 7,19 Despite these potential advantages of nitinol staples, clinical and biomechanical data supporting their efficacy for first MTP fusion is lacking.…”

“…1,13,19 Additionally, these implants can be inserted quickly 7 and are smaller than commonly used dorsal compression plates, which reduces operative time and the frequency of symptomatic implants. 7,19 Despite these potential advantages of nitinol staples, clinical and biomechanical data supporting their efficacy for first MTP fusion is lacking. Biomechanical studies performed with older-generation nitinol staples demonstrated inadequate implant strength and fatigue properties.…”

“…Newer nitinol staples have since been developed with improved design geometries (wider bridges and staple legs), resulting in superior strength and fatigue properties, superior compression across fusion surfaces, enhanced insertion devices, and easier storage requirements. 1,7,22,26,27 However, the performance of these modernized staples during a first MTP fusion has not been described. Clinical data supporting the use of modern nitinol staples for a first MTP fusion is also lacking, with limited case series documenting failures in a total of 4 patients.…”

“…1,13,19 Additionally, these implants can be inserted quickly 7 and are smaller than commonly used dorsal compression plates, which reduces operative time and the frequency of symptomatic implants. 7,19…”