Arthroeresis Procedure- flat foot implant surgery
What is the Arthroeresis Procedure? Arthroereisis (also referred to as arthroisis) is the limitation of excessive movement across a joint. Subtalar arthroereisis is designed to correct the excessive talar displacement and calcaneal eversion by placing an implant in the sinus tarsi, a canal located between the talus and the calcaneous.
Flat foot implant surgery has been performed for some 40 years, with a variety of implants designs and compositions. The Maxwell-Brancheau Arthroereisis (MBA) implant is currently favored due to the simple and reversible implantation procedure, although other devices reported in the medical literature include the STA peg and a Kalix device. The MBA implant is described as a reversible and easy to insert device with the additional advantage that it does not require bone cement. In children, insertion of the MBA implant is frequently offered as a stand alone procedure, while adults often require adjunctive surgical procedures on bone and soft tissue due to correct additional deformities.
The MBA implant received U.S. Food and Drug Administration (FDA) 510(k) marketing clearance in 1996 because it was substantially equivalent to products on the market prior to device regulation. According to the FDA summary, the primary indication for the Subtalar MBA device is “as a spacer for stabilization of the subtalar joint. It is designed to block the anterior and inferior displacement of the talus, thus allowing normal subtalar joint motion but blocking excessive pronation and the resulting sequela.” (1) The MBA Resorb Implant received 510(k) marketing clearance in 2005 (K051611). This implant employs the same basic mechanical features as the predicate MBA implant, but is composed of a material (poly l-lactic) that is resorbed by the body.
This procedure is mainly indicated in children between the ages of 8-12, but can also be used for adults. The use in adults are not beneficial as an isolated procedure. The MBA implant in adults should only be used as an adjunctive procedure only. The implant will assist the patient in reducing pronatory forces, therefore allowing the other procedures to heal quicker and easier.
Benefits of the MBA
- decreasing symptoms pain and tiring of the feet and legs
- low risk of infection
- no bone or cartilage is removed
- no holes are drilled in bone
- no bone cement is used
- the implant can be removed if necessary
Before MBA After MBA
Is my child to young for surgery on his or her feet? If your child’s foot doesn’t correct naturally, conservative treatments have failed, the problem gets worse, and your doctor is recommending surgery, correcting flat feet may prevent the pain and suffering many people go through from adolescents into adulthood. Surgery to correct the alignment of the bones in the foot, before the bones mature into an incorrect flatfoot position. Correction may enable the child to live and more active lifestyleandprevent severearthritis and possible a more complicated surgery in the future.
Is the implant removed? The MBA implant does not necessarily need to be removed. However, in a number of patients, pain may eventually develop after surgery and overtime require that the implant be removed.
How long will it take to recover after surgery? If the MBA implant is the only procedure that is performed, the recovery time is approximately two to four weeks and will vary from patient to patient. If other procedures are done with the implant such as an Achilles tendon lengthening, recovery time may be longer.
PDF version of Dr. Timko’s famous Pediatric foot lecture here: Pediatric Foot Deformities