Effect of Postoperative Ketorolac Administration on the Union Rate Following First Metatarsophalangeal Joint Arthrodesis

Abstract

Category: Midfoot/Forefoot Introduction/Purpose: To decrease postoperative opioid consumption, nonsteroid anti-inflammatory drugs (NSAIDs), including ketorolac, is considered a proper substitute with few side effects. This study aimed to assess the nonunion rate after the first metatarsophalangeal (MTP) joint arthrodesis and five-day ketorolac administration. We secondarily aimed to compare the observed rate of nonunion in our study with the reported rate of 5.4% in a systematic review. Methods: In a retrospective cohort study, we included 181 primary MTP arthrodeses from 2016 to 2020 in a single surgeon practice. The surgical technique was identical using a dorsal locking plate after preparing the joint with the cup-and-cone technique. Ketorolac was administered every 6 hours for five consecutive days postoperative. Patients were placed in a heel weight-bearing CAM boot for a minimum of 6 weeks. Union was determined radiographically at three months and the final follow- up. Nonunion was categorized as symptomatic versus asymptomatic. Results: At three months postoperative, patient characteristics did not show any statistically significant difference between union and nonunion groups. However, at the final follow-up, hallux rigidus was significantly associated with a higher rate of the union in comparison to the preexisting hallux valgus deformity (odds=3.7; P=0.04). of 181 feet, 15 (8.3%) at three months and 12 (6.6%) at the final follow-up revealed nonunion. Of 15, 7 (45%) were asymptomatic, and 8 (55%) were symptomatic. Six (75%) of the 'symptomatic' nonunion underwent an unplanned secondary surgery. Almost 50% of the asymptomatic nonunions at three months healed by the final follow-up; however, none of the symptomatic nonunions healed. Comparing the observed proportion of nonunions at three months (8.3%) and the final follow-up (6.6%) in our study to the mean nonunion rate of 5.4% found in the literature revealed no significant difference between our results and the literature (P=0.067 and 0.27, respectively). Conclusion: A short course of oral ketorolac does not seem to affect the union rate after MTP arthrodesis. Ketorolac can be used safely and effectively to decrease postoperative opioid consumption.