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Risk Factors for Failure in Hammertoe Surgery
Rachel H Albright1,2, Moiz Hassan1, Jacob Randich1
1Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA.
Insights
Hammertoe surgery can fail due to specific risk factors like increased toe deviation and certain surgical techniques. Performing first ray surgery may reduce hammertoe recurrence by 50%.
Area of Science:
- Foot and Ankle Surgery
- Orthopedic Surgery
- Reconstructive Surgery
Background:
- Hammertoe correction is a common elective foot surgery.
- High rates of symptomatic recurrence and revision surgery are noted.
- Identifying risk factors for hammertoe surgery failure is crucial.
Purpose of the Study:
- To identify patient and provider risk factors associated with hammertoe surgery failure.
- To provide guidance for surgeons in preoperative consultations.
- To help patients set realistic postoperative expectations.
Main Methods:
- Retrospective cohort study of 152 patients (311 toes) undergoing hammertoe surgery.
- Minimum 6-month follow-up in a single urban foot and ankle practice.
- Cox regression analysis used to identify predictor variables from chart and radiographic review.
Main Results:
- Increased preoperative transverse plane deviation, operating on the second toe, and using phalangeal osteotomy for proximal interphalangeal (PIP) joint reduction were significant predictors of failure.
- Less conventional PIP joint reduction techniques also increased failure risk.
- Concomitant first ray surgery reduced hammertoe recurrence by 50%.
Conclusions:
- Identified risk factors can guide surgeons during preoperative consultations.
- This information can improve patient understanding of postoperative expectations.
- Understanding these factors may lead to better outcomes in hammertoe correction surgery.
Background:
Hammertoe correction is perhaps the most common elective surgery performed in the foot, yet rates of symptomatic recurrence and revision surgery can be high. In this study, we aimed to identify patient and provider risk factors associated with failure after hammertoe surgery.
Methods:
Consecutive patients with a minimum of 6 months' follow-up undergoing hammertoe surgery within a single, urban foot and ankle practice between January 1, 2011, and December 31, 2013, served as the basis of this retrospective cohort study. Cox regression analysis was used to identify important predictor variables obtained through chart and radiographic review. One hundred fifty-two patients (311 toes) with a mean age of 60.8 ± 11.2 years and mean follow-up of 29.5 ± 21.2 months were included.
Results:
Statistically significant predictors of failure were having a larger preoperative transverse plane deviation of the digit (hazard ratio [HR], 1.03 for each degree; P < .001; 95% CI, 1.02, 1.04), operating on the second toe (vs third or fourth) (HR, 2.23; P = .003; 95% CI, 1.31, 3.81), use of a phalangeal osteotomy to reduce the proximal interphalangeal (PIP) joint (HR, 2.77; P = .005; 95% CI, 1.36, 5.64), and using less common/conventional operative techniques to reduce the PIP joint (HR, 2.62; P = .03; 95% CI, 1.09, 6.26). Concomitant performance of first ray surgery reduced hammertoe recurrence by 50% (HR, 0.51; P = .01; 95% CI, 0.30, 0.87).
Conclusion:
We identified risk factors that may provide guidance for surgeons during preoperative hammertoe surgery consultations. This information may better equip patients with appropriate postoperative expectations when contemplating surgery.
Level Of Evidence:
Level III, retrospective case series.
