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Does Decompressive Chevron Osteotomy Decrease Subchondral Bone Density of the First Metatarsophalangeal Joint in
Luca Tanel1,2, Alexis Nogier2,3,4, Floris Van Rooij2,5
1Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France.
Insights
Decompressive chevron osteotomy significantly reduces subchondral bone density in the first MTP and TMT joints. This surgical procedure for hallux rigidus also improves patient pain levels.
Area of Science:
- Orthopedic surgery
- Foot and ankle biomechanics
- Bone density analysis
Background:
- Hallux rigidus is a degenerative condition affecting the first metatarsophalangeal (MTP) joint.
- Decompressive chevron osteotomy is a surgical technique used to treat hallux rigidus.
- The impact of this osteotomy on subchondral bone density requires investigation.
Purpose of the Study:
- To evaluate the effect of decompressive chevron osteotomy on subchondral bone density in the first MTP joint.
- To assess changes in bone density in adjacent joints, including the first tarsometatarsal (TMT) and tibiotalar joints.
- To correlate radiologic findings with clinical outcomes.
Main Methods:
- A cohort of 16 feet (12 patients) with hallux rigidus underwent decompressive chevron osteotomy.
- Preoperative and 4-month postoperative standing cone beam 3D computed tomography (3DCT) scans were analyzed.
- Bone density was measured in Hounsfield units (HU), along with metatarsal length and protrusion index.
Main Results:
- Significant decreases in bone density were observed in the proximal and distal aspects of the first MTP joint (P < .001).
- The first TMT joint also showed a significant reduction in bone density (P < .001).
- No significant changes in bone density were noted in the tibiotalar joint (P = .065).
- Postoperative reductions in first metatarsal length and metatarsal protrusion index were significant (P < .001).
- Patients reported significant improvement in pain (VAS score reduction of -5.3 ± 1.9).
Conclusions:
- Decompressive chevron osteotomy results in a significant decrease in subchondral bone density of the first MTP joint.
- Bone density reduction is also evident in the first TMT joint following this procedure.
- The procedure leads to favorable clinical outcomes, including pain reduction.
Background:
To investigate the impact of decompressive chevron osteotomy on subchondral bone density at the first metatarsophalangeal (MTP) joint.
Methods:
Sixteen feet (12 patients) with hallux rigidus underwent decompressive chevron osteotomy. Standing cone beam 3D computed tomography (3DCT) were assessed preoperatively and at 4-month follow-up, and clinical data were collected. Radiologic measurements, including bone density using Hounsfield units (HU), were conducted. Statistical analyses were performed to evaluate changes and correlations.
Results:
Postoperative bone density significantly decreased in proximal (Pre, 650.9 ± 149.1; Post, 312.4 ± 115.9; P < .001) and distal (Pre, 910.4 ± 143.3; Post, 639.0 ± 167.1; P < .001) components of the first MTP joint and the first tarsometatarsal (TMT) (Pre, 762.9 ± 166.6; Post, 611.5 ± 165.9; P < .001) joint. No significant difference was measured at the tibiotalar joint (Pre, 497.5 ± 143.6; Post, 534.3 ± 130.7; P = .065). Length of the first metatarsal (Pre, 60.4 ± 3.4; Post, 54.3 ± 3.0; P < .001) and metatarsal protrusion index (MPI) (Pre, -0.9 ± 3.0; Post, -9.0 ± 3.6; P < .001) significantly decreased postoperatively. Clinical assessments showed significant improvements in pain on the visual analog scale (-5.3 ± 1.9).
Conclusion:
Decompressive chevron osteotomy leads to a significant decrease in subchondral bone density of the first MTP joint. A decrease in bone density occurs also in the first TMT joint.
Level Of Evidence:
Level IV, radiographic study.
