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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.

Foot & Ankle International
|December 17, 2024
PubMed
Summary
This summary is machine-generated.

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.

Keywords:
Hounsfield unitcomputed tomographyhallux rigidussubchondral bone density

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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.