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Symptomatic Hardware Removal After First Tarsometatarsal Arthrodesis
Kyle S Peterson1, Jeffrey E McAlister2, Christopher F Hyer3
1Foot and Ankle Surgeon, Suburban Orthopaedics, Bartlett, IL.
Summary
Approximately 15% of patients undergoing first tarsometatarsal joint arthrodesis require hardware removal due to pain or irritation. This often occurs within nine months after surgery, with locking plates and lag screws being most common.
Area of Science:
- Orthopedic surgery
- Foot and ankle reconstruction
- Biomaterials in orthopedics
Background:
- Severe hallux valgus and proximal instability cause forefoot pain and deformity.
- First tarsometatarsal joint arthrodesis is a common surgical solution.
- Dorsomedial locking plates with lag screws offer strong fixation but raise concerns about prominence and removal.
Purpose of the Study:
- To determine the incidence of symptomatic hardware after first tarsometatarsal joint arthrodesis.
- To assess the rate of hardware removal due to prominence or discomfort.
Main Methods:
- Retrospective review of 165 patient medical records.
- Analysis of patients who underwent first tarsometatarsal joint arthrodesis with plate fixation.
- Outcome measured was symptomatic hardware removal following clinical union.
Main Results:
- 15.2% (25 of 165) of patients had hardware removed for pain/irritation.
- 18 patients had locking plates and lag screws removed; 7 had crossing lag screws removed.
- Symptomatic hardware removal occurred at a median of 9.0 months post-surgery.
Conclusions:
- Hardware prominence and discomfort necessitating removal are common after first tarsometatarsal joint arthrodesis.
- Surgeons should counsel patients on the approximate 15% incidence of symptomatic hardware removal.
- Understanding hardware complication rates aids in patient informed consent and surgical planning.
