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First Metatarsophalangeal Joint Arthrodesis for Moderate to Severe Hallux Valgus: Complications and Patient-Reported
Rebecca Lewis1, Katie Hepburn2, Fraser Harrold3
1Department of Trauma & Orthopaedics, NHS Tayside, Ninewells Hospital & Medical School, Dundee, United Kingdom.
Background:
Hallux valgus (HV) is a painful deformity of the first ray characterised by lateral deviation of the proximal phalanx and medial displacement of the metatarsal head. There are multiple surgical options for its management, including arthrodesis. In our institution, first metatarsophalangeal joint (MTPJ) arthrodesis is preferred over corrective osteotomy for patients with severe HV. This study aimed to investigate the outcomes of patients undergoing first MTPJ arthrodesis for HV. The primary outcome measures were Patient-Reported Outcome Measures (PROMs), the Manchester-Oxford Foot Questionnaire (MOxFQ), and the EuroQol-5 dimensions (EQ5D) score. Secondary outcome measures were complications, including non-union, recurrence, pain, reoperation, and infection.
Methods:
This was a single-center, case series study with retrospective case note review of prospectively collected data. Caldicott approval was granted. Inclusion criterion was all patients undergoing arthrodesis for HV between 2016 and 2021. Exclusion criterion was patients with inadequate operative information.
Results:
62 feet were included with an average preoperative HV angle (HVA) of 40.2 degrees (range, 19.6-82.0) and an average preoperative intermetatarsal angle (IMA) of 15.9 degrees (range, 2.7-26.4). All first MTPJ arthrodeses were performed between January 2016 and June 2021. The average improvement in composite MOxFQ scores was 33.0 points at 26 weeks (P < .001), sustained at 52 weeks and 2 years (P = .219 and P = .008, respectively). The average improvement in EQ5D time trade-off score was 0.217 at 26 weeks (P < .001), sustained at 52 weeks and 2 years (P = .918 and P = .975). Complications occurred in 12 of 62 (19.4%) feet, including nonunion (9.7%, n = 6), ongoing pain (11.3%, n = 7), and prominent metalwork requiring removal (4.8%, n = 3).
Conclusion:
Our results suggest that first MTPJ arthrodesis for HV has satisfactory early term patient-reported outcomes. Improvement in PROMs is apparent by 26 weeks and sustained at 2 years postoperatively. There was a high overall complication rate (19.4%), with a non-union rate of 9.7%.
