Clinical and Radiological Results of a Human Bone Graft Screw in Tarsometatarsal II/+III Arthrodesis

Abstract

Category: Midfoot/Forefoot Introduction/Purpose: Osteoarthritis of the lesser Lisfranc joints is a debilitating foot condition. Arthrodesis is a well known procedure to eliviate pain and improve quality of life of the affected person. The use of a transplant screw made of allogenic human bone material is considered a new technique for lesser Lisfranc joint arthrodesis. This article investigates the clinical outcome and radiological integration of the allogenic bone screw for arthrodesis of the tarsometatarsal joints II/+III. Methods: This is a prospective study involving 20 feet of 17 patients who received TMT II/+III arthrodesis with an allogenic bone screw. A Visual Analogue Scale (VAS pain and function), Foot Function Index (FFI), American Orthopaedic Foot & Ankle Society Outcome Score (AOFAS) and Foot and Ankle Outcome Score (FAOS) were used as measures to compare preoperative with postoperative results. Radiologic integration in the recipient bone was also evaluated. Results: A significant mean pre- to postoperative improvement of all evaluated scores has been observed (P< .05) after a mean follow-up of 16 months (12-33). VAS (pain) decreased from 7.6 points to 1.4 points, VAS (function) from 7.25 points to 1.8 points. The FFI improved from 62.3% to 16.7%, the AOFAS score from 29.7 points to 79.9 points of the. In all surveyed subscales of the FAOS score an increase was observed: symptoms: 55.2 to 85.6; pain: 30.5 to 86.9; function: 33.1 to 88.3; quality of life: 27.8 to 79.7. The radiologic evaluation did not show any pseudarthrosis at last follow-up. Moreover, in 19 of 20 feet (95%) a complete radiological integration of the screw into the receiving bone was seen after a minimum follow-up time of 12 months and was no longer distinguishable from the original bone. Conclusion: With these first results of the use of an allogenic bone screw in TMT II/+III arthrodesis, a significant improvement from preoperative to postoperative clinical status was confirmed and a full radiographic integration demonstrated in all feet.