Effect of Pathology on Patient Reported Outcomes of MTP Arthrodesis

Abstract

Category:Ankle; Midfoot/ForefootIntroduction/Purpose:Metatarsophalangeal (MTP) joint arthrodesis of the hallux is a common and reliable procedure performed on patients with various pathologies including hallux rigidus and hallux valgus. While the effect of foot pathology on MTP arthrodesis union rates has been previously explored, there is a lack of literature comparing long term patient reported outcomes between pathology types. The purpose of this present study was to compare patient reported and clinical outcomes following MTP fusion between those with hallux valgus and hallux rigidus.Methods:Patients undergoing primary MTP arthrodesis from 2010-2020 were identified. Additionally, Radiographic follow-up of >12 weeks, no ongoing ipsilateral infection, and complete response to a postoperative patient report outcomes (PROMIS AND Foot Function Index (FFI)) survey were required. After these criteria, 112 patients remained and were grouped by hallux valgus (HV, 53) and hallux rigidus (HR, 59). Medical records were examined for patient characteristics, operative variables, and complications. Patients were grouped by indication and compared.Results:Nonunion rates and complications including wound dehiscence, infection, and reoperation were not different between indications. Patients completed the patient reported outcomes instruments a median of 1.9 years (IQR 2.6) postoperatively. All patient reported outcomes measures were not significantly different between pathology groups with PROMIS physical function ((median, IQR) HR 44.6, 9.9 vs. HV 44.1, 12.2), pain interference (HR 52.8, 9.9 vs. HV 52.4, 12.3), FFI pain scale (HR 33.3, 40.0 vs. HV 28.3, 37.0), FFI disability scale (HR 30.0, 41.0 vs. HV 28.9, 41.0), FFI activity limitation scale (HR 10.0, 27.0 vs. HV 10.0, 23.0), and FFI total (HR 25.8, 50 vs. HV 37.4, 37).Conclusion:Arthrodesis of the first MTP joint provides similar nonunion and complication rates between hallux valgus and rigidus groups. At intermediate follow-up, MTP arthrodesis provides comparable validated patient reported outcomes scores between these two groups. Surgeons should be aware of these results when prognosticating the effect of MTP arthrodesis.