Objective:

To evaluate the clinical and radiographic outcomes of subtalar arthroereisis in pediatric and adolescent patients with flexible flatfoot, comparing bioabsorbable and metallic implants.

Key Findings:

• Subtalar arthroereisis improved clinical and radiographic outcomes regardless of implant material.
• Bioabsorbable implants were associated with fewer implant-related symptoms and nonroutine removals compared to metallic implants.
• Persistent sinus tarsi pain occurred in about 8% of metallic and 6% of bioabsorbable cases.
• Nonroutine implant removal occurred in about 8% of metallic and 5% of bioabsorbable cases.
• Radiographic outcomes improved significantly in both groups, with no consistent evidence of superiority for either implant type.

Interpretation:

Bioabsorbable devices may offer modest advantages in reducing persistent sinus tarsi pain and nonroutine removals compared to metallic implants, but the evidence is limited and of low to moderate certainty.

Limitations:

• Limited comparative evidence with only two nonrandomized cohort studies directly comparing implant types.
• Most studies were retrospective with a moderate risk of bias.
• Follow-up duration was typically limited to 2 to 3 years.
• Heterogeneity in implant design, surgical technique, and concomitant procedures across studies.

Conclusion:

Implant selection should be individualized based on patient age, deformity severity, and surgeon experience due to the limited certainty of comparative evidence.