Comparison of Weil Osteotomy and Cheilectomy for Second Metatarsophalangeal Joint Osteoarthritis

Abstract

Category: Midfoot/Forefoot Introduction/Purpose: Second metatarsophalangeal (MTP) joint osteoarthritis (OA) was newly introduced at 2013. However, treatment of second MTP joint OA was not reported yet. The purpose of this study was to investigate the difference in clinical and radiographic outcomes between a chilectomy and an Weil osteotomy for treatment of second MTP joint OA. Methods: From August 2007 to January 2015, 61 feet of 51 patients who had been operated for second MTP joint OA by were retrospectively reviewed. The cheilectomy involved removal of bone spur on the second MTP joint. And the Weil osteotomy involved shortening of second metatarsal bone and removal of the bone spur (Fig.1). The average age was 60 years (95% CI: 57-62 years), the mean duration of follow up was 15 months (95% CI: 12-17months). The 61 feet were divided into two groups, the cheilectomy-group (36 feet) and the Weil-osteotomy-group(25 feet). The preoperative and the last follow-up radiological values and clinical values were measured. Length of the second metatarsal relative to the fourth (2-4 MT length ratio), second MTP joint OA grade, and Visual Analogue Scale (VAS) of pain were measured to evaluate clinical and radiological outcomes. Further, prevalence of second MTP joint disturbance at the time of last follow-up was measured. Results: There were no significant differences of age (P=0.83), gender (P=0.08), BMI (P=0.09), the preoperative 2-4 MT length ratio (P=0.68) and the second MTP joint OA grade (P=0.21) between the chilectomy-group and the Weil-osteotomy-group. In the cheilectomy-group, the last follow-up 2-4 MT length ratio and second MTP joint OA grade were not statistically different from the preoperative values. In the Weil-osteotomy-group, there was a significant decreasing of the 2-4 MT length ratio and a significant improvement of the second MTP joint OA grade between the preoperative values and the last follow-up values. For both the cheilectomy-group and the Weil-osteotomy-group, there was a significant improvement of the VAS of pain after treatment. However, the cheilectomy-group showed the statistically higher prevalence of second MTP joint disturbance than the Weil- osteotomy-group (Table.1). Conclusion: The Weil-osteotomy group showed superior result than the cheilectomy group clinically and radiologically in this study. Because shortening of second metatarsal bone could reduce a pressure of second MTP joint, joint space widening and joint disturbance decreasing could be achieved after the Weil osteotomy. We therefore recommend the Weil osteotomy as a treatment of second MTP joint OA.