Extensive Implant Reaction in Failed Subtalar Joint Arthroereisis: Report of Two Cases

HSS Journal


David M. Scher, MD

Associate Attending Orthopedic Surgeon, Hospital for Special Surgery
Associate Professor, Weill Cornell Medical College

Manjula Bansal, MD

Attending Pathologist, Chief Clinical Pathologist
Associate Professor of Clinical Pathology, Weill Cornell Medical College

Walther H.O. Bohne, MD

Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor, Weill Cornell Medical College

Sheryl Handler-Matasar MD
Department of Orthopaedic Surgery, Hospital for Special Surgery

Abstract:
Foreign body synovitis with extensive granulomatous giant cell reaction to refractile polyethelene debris is a complication of subtalar arthroereisis not previously reported.  We present two cases whereby STA-peg implants were used to treat bilateral painful flexible flatfoot deformities in children. Two boys, presented at 7 and 10 years of age, two years following STA-peg procedures and tendo-Achilles lengthening for painful flatfeet.  They each had minimal subtalar motion and pain at the sinus tarsi.  Radiographs demonstrated surgical defects in the calcaneus with surrounding high signal on the MRI in the subchondral bone of the calcaneus and talus.  Both patients failed conservative management and had their implants removed with good relief of their pain.  Histology was submitted at the time of implant removal.  We present the radiographic and pathologic findings seen in these two patients with failed subtalar arthroereisis due to extensive implant reaction.  The pathologic process seen in these patients is a previously unreported complication of this procedure.  We do not recommend arthroereisis in the treatment of painful flexible flatfoot in children.

This article appears in HSS Journal: Volume 3, Number 2.
View the full article at springerlink.com.

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.

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