Multicenter Early Radiographic Outcomes of Triplanar Tarsometatarsal Arthrodesis With Early Weightbearing

Abstract

Background:Hallux valgus is a multiplanar deformity of the first ray. Traditional correction methods prioritize the transverse plane, a potential factor resulting in high recurrence rates. Triplanar first tarsometatarsal (TMT) arthrodesis uses a multiplanar approach to correct hallux valgus in all 3 anatomical planes at the apex of the deformity. The purpose of this study was to investigate early radiographic outcomes and complications of triplanar first TMT arthrodesis with early weightbearing.Methods:Radiographs and charts were retrospectively reviewed for 57 patients (62 feet) aged 39.7 ± 18.9 years undergoing triplanar first TMT arthrodesis at 4 institutions between 2015 and 2017. Patients were allowed early full weightbearing in a boot walker. Postoperative radiographs were compared with preoperative radiographs for hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), and lateral round sign. Any complications were recorded.Results:Radiographic results demonstrated significant improvements in IMA (13.6 ± 2.7 degrees to 6.6 ± 1.9 degrees), HVA (24.2 ± 9.3 degrees to 9.7 ± 5.1 degrees), and TSP (5.0 ± 1.3 to 1.9 ± 0.9) from preoperative to final follow-up ( P < .001). Lateral round sign was present in 2 of 62 feet (3.2%) at final follow-up compared with 52 of 62 feet (83.9%) preoperatively. At final follow-up, recurrence was 3.2% (2/62 feet), and the symptomatic nonunion rate was 1.6% (1/62 feet). Two patients required hardware removal, and 2 patients required additional Akin osteotomy.Conclusion:Early radiographic outcomes of triplanar first TMT arthrodesis with early weightbearing were promising with low recurrence rates and maintenance of correction.Level of Evidence:Level IV, retrospective case series.

Effect on Foot Width With Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus

“…Several recent studies have demonstrated low nonunion rates and maintained correction after a first TMT arthrodesis, even with early weightbearing. 1,5,6,8,9 It is important to mobilize patients early after surgery to avoid the complications of prolonged immobilization. The results of our study showed that significant reductions in bony and soft tissue foot widths may still be achieved after a triplanar first TMT arthrodesis with early weightbearing.…”

“…The detailed operative technique has been previously published. 9 In summary, a dorsal longitudinal incision was centered over the first TMT joint. The first TMT joint was exposed dorsally and medially via subperiosteal dissection, followed by a plantar release of the joint.…”

Analysis of Shortening and Elevation of the First Ray With Instrumented Triplane First Tarsometatarsal Arthrodesis

“…The operative procedure has been described earlier in detail (Supplemental Video). 31,36,39,40 Although severity-based algorithms would advocate distal metatarsal procedures for lower IMAs, it was the authors’ preference to address the deformity from an anatomic basis at the center of rotation and angulation. 18 The main principle of the technique was a “correct then cut” method using a precision standardized cutting guide that allowed for minimal bone resection of joint surfaces while aligning the first ray in 3 dimensions.…”

A Double-Edged Sword: Direct-to-Consumer Advertising

“…Although the concept of 3-dimensional deformity correction is novel and exciting in hallux valgus surgery, it is not unique to Lapiplasty and longer-term studies are needed to critically evaluate clinical outcomes. 9,11…”