Early results of minimally invasive, reverse-oblique, distal metaphyseal metatarsal osteotomy (R-DMMO) for arthritis of the lesser tarsometatarsal joints — A retrospective case series

Abstract

BackgroundArthrodesis is the gold standard for operative management of osteoarthritis of the lesser tarsometatarsal joints (TMTJs) but is not without complications. Our early results of a minimally invasive alternative treatment – the reverse-oblique distal metaphyseal metatarsal osteotomy (R-DMMO) are described. MethodsThis is a single-centre, single-surgeon, retrospective series of patients with isolated, symptomatic lesser TMTJ arthrosis who underwent R-DMMO. ResultsSixteen feet in 15 patients were included. The mean age was 64.7±9.7 years and mean duration of follow-up was 109.4±27.4 weeks. There were no non-unions, infections or wound complications. Two patients developed transfer symptoms to their first metatarsal, one of these patients improved after three months. There was one delayed union which united at 12 months. Two patients developed recurrence of symptoms but felt that they were still improved compared to preoperatively and no patient has required arthrodesis thus far. The mean preoperative VAS was 8.3±1.3 and the mean postoperative VAS was 2.4±2.2 (P<0.001). The mean postoperative MOxFQ-Walking was 25.2±25.6, MOxFQ-Pain was 24.8±20.5, MOxFQ-Social was 18.4±19.1, and MOxFQ-Index was 23.4±20.6. Eight patients were ‘very satisfied’ and seven were ‘satisfied’ with the procedure. ConclusionsR-DMMO is a minimally invasive and safe procedure for lesser TMTJ arthrosis which can produce good results and prevent, or at least delay, the need for arthrodesis without compromising future operative options. Good to excellent outcomes have been shown with few significant complications in the short term in selected patients.