Is it Necessary to Re-Fuse a Non-Union of a Hallux Metatarsophalangeal Joint Arthrodesis?

Hope, Matthew; Savva, Nicholas; Whitehouse, Sarah L.; Elliot, Robin; Saxby, Terence S.

doi:10.3113/fai.2010.0662

Cited by 27 publications

(7 citation statements)

References 15 publications

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“…Hope et al (2010) described acceptable outcome scores with only removal of material and debridement in 7 of 11 patients. In our series, the 2 patients with hardware failure did not want further treatment, which confirms that some patients tolerate a non-union well.…”

Section: Discussionmentioning

confidence: 95%

Pseudoarthrosis repair after failed metatarsophalangeal 1 arthrodesis

Takács¹,

Swierstra²

2011

Acta Orthopaedica

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Section: Discussionmentioning

confidence: 95%

Pseudoarthrosis repair after failed metatarsophalangeal 1 arthrodesis

Takács¹,

Swierstra²

2011

Acta Orthopaedica

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“…In a level III retrospective study of failed hallux MTPJ arthrodeses, Hope et al showed significantly higher nonunion rates in patients who had undergone previous surgery. 42 Easley et al similarly showed that a previous attempt at subtalar arthrodesis is a significant predictor of nonunion in their level IV retrospective review. 26 Overall, there is fair evidence (grade B recommendation) to implicate soft tissue injury as a risk factor for nonunion.…”

Section: Soft Tissue Injurymentioning

confidence: 96%

Current Concepts Review: Risk Factors for Nonunions in Foot and Ankle Arthrodeses

2012

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Systemic FactorsDiabetes Cigarette smoking Alcohol Osteoporosis Nonsteroidal anti-inflammatory drugs Age Obesity Compliance with weight bearing Local Factors Infection Vascularity and avascular necrosis Soft tissue injury and revision surgery Surgical Factors Mechanical Factors Construct stability Interfragmentary gaps Surgeon FactorsHigh-volume vs. low-volume surgeons foot or ankle. The efficacy of strategies to modify the risk of delayed or failed healing after arthrodesis is also reviewed. PATIENT FACTORS Systemic risk factorsBiological variation of the host and genetic predisposition have been recognized as important factors in bone healing. 31 Comorbidities, including diabetes, rheumatoid arthritis, and smoking, have been postulated to have a negative impact on bone healing. Recently, genomic studies have suggested that variation in host biology may be highly dependent 1031 1032

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“…Hardware removal combined with debridement is another reasonable option. 5,17 There are various publications on risk factors for nonunion after first MTPJ arthrodesis, 8,32,33 albeit with much heterogeneity in terms of patient population and treatment. 20,26 Hence this study aimed to determine the potential association of patient factors, joint preparation, joint fixation, joint positioning, and postoperative immobilization on the incidence of nonunion.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Multicenter Retrospective Cohort Study

et al. 2023

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Background: Arthrodesis of the first metatarsophalangeal joint is the current treatment of choice for symptomatic advanced hallux rigidus and moderate-to-severe hallux valgus. There are different methods to perform arthrodesis, yet no consensus on the best approach. Therefore, this study aimed to determine the effects of preoperative and postoperative hallux valgus angle (HVA), joint preparation and fixation technique, and postoperative immobilization on the incidence of nonunion. Methods: A retrospective multicenter cohort study was performed that included 794 patients. Univariate and multiple logistic regression was conducted to determine associations between joint preparation, fixation techniques, postoperative immobilization, weightbearing, and pre- and postoperative HVA with nonunion. Results: Nonunion incidence was 15.2%, with 11.1% symptomatic and revised. Joint preparation using hand instruments (OR 3.75, CI 1.90-7.42) and convex/concave reamers (OR 2.80, CI 1.52-5.16) were associated with greater odds of a nonunion compared to planar cuts. Joint fixation with crossed screws was associated with greater odds of nonunion (OR 2.00, CI 1.11-3.42), as was greater preoperative HVA (OR 1.02, CI 1.00-1.03). However, the latter effect disappeared after inclusion of postoperative HVA in the model, with a small association identified between residual postoperative HVA and nonunion (OR 1.04, CI 1.01-1.08). Similarly, we found an association between odds of nonunion and higher body weight (OR 1.02, CI 1.01-1.04) but not of body mass index. Conclusion: Based on our results, first metatarsophalangeal joint arthrodesis with planar cuts and fixation with a plate and interfragmentary screw is associated with the lowest odds of resulting in a nonunion. Higher body weight and greater preoperative HVA were associated with slight increase in rates of nonunion. It is crucial to properly correct the hallux valgus deformity during surgery. Level of Evidence: Level III, retrospective case control study.

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Is it Necessary to Re-Fuse a Non-Union of a Hallux Metatarsophalangeal Joint Arthrodesis?

Cited by 27 publications

References 15 publications

Pseudoarthrosis repair after failed metatarsophalangeal 1 arthrodesis

Pseudoarthrosis repair after failed metatarsophalangeal 1 arthrodesis

Current Concepts Review: Risk Factors for Nonunions in Foot and Ankle Arthrodeses

Factors Associated With Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Multicenter Retrospective Cohort Study

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