Trends in Foot and Ankle Surgery: Hardware Removal and the Use of Bioabsorbable Implants

Research output: Book/ReportDoctoral thesisCollection of Articles


In Finland, first ray surgical indications and techniques have varied over time. Be- cause foot surgery is still a relatively new and narrow subspecialty within orthopedic surgery, there is very little systematic follow up or knowledge in foot surgery. The aim of this dissertation was to establish the number of first ray surgeries performed in recent years and to find out whether there have been any changes in surgical procedures during this time. A further aim is to ascertain the removal rate for metallic implants after ankle fracture surgery.

Bioabsorbable materials first came into use in the 1980s and became a keen focus of research thereafter. One part of this dissertation deals with bioabsorbable mate- rials in foot and ankle surgery. In this part of the study, the long-term results of a bioabsorbable interpositional implant were investigated and bioabsorbable screws were compared with titanium alloy screws in two biomechanical specimens.

Two of the main findings of the study were that the incidence of HV surgery reduced significantly between 1997 and 2014 and that the rate of implant removal was as high as 27% after ankle fracture surgery. A clinical follow-up study found that the bioabsorbable interpositional implant achieved good long-term results in MTP- 1 surgery. Furthermore, in this dissertation, it is demonstrated that a bioabsorbable screw may work equally well in TMT-1 and MTP-1 arthrodesis, although a clinical study is still required to verify this finding.

This dissertation describes a surgical technique in TMT-1 and MTP-1 surgeries that could lead to the future replacement of titanium alloy and steel implants. In the first part of the study, it was found that these surgical techniques have recently gained popularity. The finding of this dissertation demonstrate that the implant materials currently in use have drawbacks, such as stress-shielding and associated soft tissue irritation in addition to the significant economic cost to society of the large number of hardware removal operations. These bioabsorbable implant materials are, of course, still under development and still require more development and further research before they are ready to completely replace existing implant materials.
Original languageEnglish
Place of PublicationTampere
PublisherTampere University
ISBN (Electronic)978-952-03-2095-9
ISBN (Print)978-952-03-2094-2
Publication statusPublished - 2021
Publication typeG5 Doctoral dissertation (articles)

Publication series

NameTampere University Dissertations - Tampereen yliopiston väitöskirjat
ISSN (Print)2489-9860
ISSN (Electronic)2490-0028


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