Yeah I agree, I honestly just wanted to try it out and see how the patient did. She was refusing fusion although that’s really what she needed. Cheilectomy alone wouldn’t have done anything for her so I have this a shot. To my surprise she is very happy and already with 1/10 pain compare to her 8/10 pre-op and I did the case 9 weeks ago.
I met diversity and case numbers I already have double what I need. I’m just going to wait 1 more year because I had some family stuff going in this year and wasn’t prepared to apply for cert yet. Thanks for your advice.
Yeah, cheilectomies work great for a year or two or occasionally 5 or rarely 10+. Implants can too. The problem is that people live longer than that.
...Follow-up is the enemy of "good" surgery.
I am against doing surgery that is a temp fix (always aim for long term results and last invasive procedure for that problem), but if you want to do joint salvage rigidus surgery, the key is not burning too much bone for the inevitable fusion.
That is why implants are so lame... nearly all will require bone graft, most even ream the medullary canals that are the main blood supply to the fusion site and the graft.
I think checilectomies might work awhile for early limitus, but those people who'd be fair candidates honesly are not even making a doc appointment - much less thinking surgery. They just crunch ibuprofen or push through the discomfort.
I probably do a 20-to-1 of MPJ fusion to checilectomy (no implants).
I have fused
far more failed cheilectomies than I have done primary cheilectomies. Some fail within a year or two (yet orig surgeon probably thinks they did great???).
If I do checilectomy, I do mine super aggressive Valente (basically just leave plantar third or quarter of the joint - so that some DBM putty dorsal and a good plate will still fuse it later). That is pretty rare and usually only for low activitiy retirees.
...You have to just let the people walk away who don't understand or won't do what they need (fusion, amp, proper recovery course, weight loss, better glu control, whatever).
They have unrealistic expectations, just like the ones who read there is 2 week bunion surgery recovery on insta or want to do bilateral flat foot recons. It's tough to "lose the patient" since podiatry is saturated and patients are at a premium, but when it comes to patient trying to dictate or compromise doc decision on expensive and invasive procedures, just cut them loose. Even if their surgery turns out fair or well on XR, they are unlikely to be happy. They will fail or need another surgery soon enough, and revision is rough and higher legal risk also. So, personally, I avoid staged or temporary or set-up surgery whenever I can (for elective stuff).
Fwiw, on MPJ fusions (or ankle or STJ or whatever) I just tell them "
fusion is 'what your body is doing naturally anyways... throwing up bone spurs, less and less motion, more and more inflammation.' We are just expediting that process to relieve pain and making sure it ends in best position. Fusion is durable and very functional." If they're educated, you can also show them the abstract (any of dozens of them, I use JBJS) with fusion vs implant results and revision rates.
I am not a resident. I am logging in PLS for ABFAS cert.
