First Metatarsophalangeal Arthrodesis After Failed Distal Chevron Osteotomy for Hallux Valgus

Abstract

Background: The purpose of this study was to compare the clinical outcomes after first metatarsophalangeal (MTP) joint arthrodesis for hallux rigidus between patients who underwent primary arthrodesis and those who had had a prior surgery for hallux valgus. Methods: Our design was a retrospective cohort study comparing 29 patients who underwent primary arthrodesis (primary group) and 34 patients with hallux rigidus after hallux valgus surgery (secondary group). The clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score and a visual analog scale (VAS) for pain. Radiological evaluation was also performed. Overall, the mean postoperative follow-up was 3.4 (range, 2-5) years. Results: At final follow-up, AOFAS and VAS pain scores significantly improved in both groups ( P = .001). However, the mean AOFAS ( P = .001) and VAS pain ( P = .008) scores were significantly better in the primary group than in the secondary group. Radiologically, there were no significant differences between the groups in any angle after arthrodesis. Revision surgeries were not required in the primary group. In the secondary group, there was 1 revision due to deep infection, and 3 other patients required dorsal plate removal. Excluding plate removal, the Kaplan-Meier survival at 3 years was not significantly different between groups ( P = .775). Conclusion: Although arthrodesis of the first MTP joint was an effective procedure for hallux rigidus, the clinical outcomes in patients who had prior hallux valgus surgery were worse than those for patients who underwent primary surgery for hallux rigidus. Level of Evidence: Level III, retrospective cohort study.

Effect of Obesity on Patient-Perceived Outcomes After First Metatarsophalangeal Joint Arthrodesis

“…First MTP fusion reliably produces satisfactory patient outcomes including improved function and decreased pain, 2,4,5,36 and remains the gold standard in the treatment of advanced first MTP arthritis. 37 A 2021 systematic review of 570 patients undergoing first MTP arthrodesis conducted by França et al 38 showed greater than 90% patient satisfaction rate with revision rates ranging from 0% to 20.5%.…”

“…First metatarsophalangeal joint (MTPJ) arthrodesis is a commonly performed procedure for patients with various disorders of the first ray including hallux rigidus, severe hallux valgus, failed 1st MTPJ replacement, and failed hallux valgus correction. 1 Outcomes are generally favorable with reported fusion rates greater than 90% with commensurate improvements in patient-reported outcomes including function, satisfaction, and pain [2][3][4][5] Patients can return to being active and participate in sports such as golf and tennis with no functional consequence. 6 The importance of various surgical factors on patient outcomes of first MTP joint arthrodesis has been previously studied, 1 and while certain patient-related factors have generally been associated with worse outcomes in elective foot and ankle surgery, 3,[7][8][9][10][11] there is limited data on how these specifically correspond to Effect of Obesity on Patient-Perceived Outcomes After First Metatarsophalangeal Joint Arthrodesis patients undergoing 1st MTPJ arthrodesis.…”

“…First metatarso-phalangeal joint (MTPJ) arthrodesis is a commonly performed procedure for patients with various disorders of the first ray including hallux rigidus, severe hallux valgus, failed 1st MTPJ replacement, and failed hallux valgus correction. 1 Outcomes are generally favorable with reported fusion rates greater than 90% with commensurate improvements in patient-reported outcomes including function, satisfaction, and pain 2-5 Patients can return to being active and participate in sports such as golf and tennis with no functional consequence. 6…”

Primary Isolated Arthrodesis of the First Metatarsophalangeal Joint for Hallux Rigidus: Clinical, Radiologic, and Pedobarographic Evaluation

“…Indications include end-stage MTP osteoarthritis, selected cases of hallux valgus, inflammatory arthritis, and failed first MTP joint surgery. 8 , 10 , 23 , 47 , 50 The procedure is commonly performed in patients with advanced hallux rigidus. 22 In such cases, arthrodesis is supposed to provide more effective pain relief when compared to several motion-preserving alternatives.…”

Effects of Short-Term Limitation of Movement of the First Metatarsophalangeal Joint on the Biomechanics of the Ipsilateral Hip, Knee, and Ankle Joints During Walking

“…The transmission of joint motion compensation affects dynamic parameters such as joint load [ 10 ]. There are FMJ lesions in many patients with hip, knee, and ankle lesions, especially those with knee arthritis [ 11 ]. At present, there is a lack of literature on this relationship, according to the preliminary experimental basis [ 12 ].…”