Outcome of Concomitant First Metatarsophalageal and Tarsometatarsal Arthrodesis for Severe Hallux Valgus

Abstract

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Arthrodesis of the first tarsometatarsal (TMT-1) joint is a widely accepted procedure for treatment of hallux valgus (HV) with medial column instability secondary to unstable first ray, midfoot arthritis, and severe or recurrent deformities with high intermetatarsal angles (IMA). Similarly, metatarsophalangeal fusion (MTP-1) has been suggested for severe hallux valgus, metatarsophalangeal arthritis, and severe or recurrent deformities. Prior studies have demonstrated early outcomes in a small sample of patients. This study aimed to evaluate clinical and radiographic outcomes in patients with severe HV who underwent concomitant TMT-1 and MTP-1 arthrodesis for severe HV. Methods: All patients with symptomatic severe HV who failed conservative management and underwent concomitant MTP-1 and TMT-1 arthrodesis between January 2006 to December 2018 were included in our retrospective case series. Patients were operated on by one of three senior foot and ankle surgeons at a single tertiary center. Demographics, clinical outcomes, patient comorbidity information, and radiographic outcomes including baseline hallux valgus angle (HVA), IMA 1-2, hallux valgus interphalangeus angle, distal metatarsal articular angle, and sesamoid station were collected. The primary outcome was reoperation. Secondary outcomes were minor complications (local wound care, use of antibiotics, and skin dehiscence), visual analogue scale (VAS) pain scores, and change in radiographic measurements. Results: From 2006 to 2018, 42 patients (21.4% male, 78.6% female) at an average age of 62.6 years (range 48 to 80) met inclusion. At final average clinical follow up of 28 months, there were a total of 23 reoperations in 35.7% of patients at an average 18.5 months from index surgery (n=15; 1 revision TMT, 2 revision MTP, 1 hallux interphalangeal (IP) fusion, and 11 hardware removal). Minor complications were present in 7.1% of patients (n=3; 3 local wound care, 2 use of antibiotics, and 3 skin dehiscence). Average VAS score preoperatively and postoperatively was 5.5 to 1.9, respectively. Average preoperative HVA and IMA 1-2 angles were 35.6 and 15.3 degrees compared to postoperative angles of 9.0 and 9.3 degrees, respectively. Conclusion: The present study demonstrates concomitant MTP-1 and TMT-1 arthrodesis in cases of HV secondary to medial column instability secondary to unstable first ray, midfoot arthritis, and severe or recurrent deformities with high IMA has a high correction capability and achieved normal HVA as well as normal IMA 1-2 at greater than two years. Concomitant MTP-1 and TMT-1 arthrodesis in patients with severe HV appeared to be safe and clinically successful.