Reoperations after tarsal coalition resection: a population-based study.
Khoshbin A., Bouchard M., Wasserstein D., Leroux T., Law PW., Kreder HJ., Daniels TR., Wright JG.
Few studies have evaluated the incidence of subsequent operations after tarsal coalition resection. Using administrative databases, we followed up a cohort of patients who had undergone tarsal coalition resection to determine the rates and possible risk factors for subsequent resection or arthrodesis. Patients (aged 8 years or older) who had been treated from July 1994 to August 2009 in Canada were identified and included. Those with nonidiopathic coalitions were excluded. The time-to-event data for the earliest subsequent procedure were fit to a Cox proportional hazards model that evaluated the patient, operative, and provider factors. Controlling for covariates, the hazard ratios were computed; however, the laterality of any subsequent operation could not be confirmed. A total of 304 patients underwent tarsal coalition resection at an average age of 24.2 ± 17.5 years. Of these 304 patients, 26 (8.6%) underwent subsequent resection and 16 (5.3%) mid- or hindfoot arthrodesis. Of all the factors, the need for future fusion was more likely only if the primary resection had been performed at an academic hospital or if the patient had undergone concomitant arthrodesis at primary resection of the coalition (hazard ratio 3.0, 95% confidence interval 1.1 to 8.5; and hazard ratio 9.7, 95% confidence interval 1.7 to 56.1, respectively). The incidence of reoperation after primary tarsal coalition resection was low in our cohort. More than 85% of our patients never required additional operative intervention an average of 9 years after the initial resection. Our data also suggest that primary treatment of tarsal coalition with resection and concomitant arthrodesis increases the risk of requiring a second fusion in the future.