MTP-1 Arthrodesis Research Articles

Silicone Arthroplasty as an Alternative to Arthrodesis in the Metatarsophalangeal Degenerative Disease of Hallux Valgus-A 5-Year Observational Study.

Background: Arthroplasty is gaining more and more popularity in the treatment of osteoarthritis (OA) of the metatarsophalangeal I joint (MTP1). The aim of our study was to evaluate the early and long-term objective clinical and radiographic results, as well as the subjective results, of MTP1 arthroplasty in comparison to MTP1 arthrodesis among patients with OA and a valgus deformity of their MTP 1 joint. Methods: Patients with OA MTP1 were examined before surgery and in the 5-year period after surgery. The inclusion criteria for the study were OA of the MTP1 joint and a non-axial position of the toe in valgus between 20 and 40 degrees. Prostheses were created for the patients with higher demands for mobility of their MTP 1 joint and arthrodesis was carried out for those with lower expectations. The treatment outcomes were assessed by clinical examination, radiography, the AOFAS scale, the SEFAS scale, and using patient-related outcome measures (PROM). Results: A total of 39 people, 37 women and 2 men, aged 55 to 67 years old (average, 61 years old) participated in the study. During the follow-up period, there were no complications in the form of infection or a loosening of the implant after both arthroplasty and arthrodesis. The follow-up examination 60 months after the surgery showed an improvement in scores (>20 points) on both the AOFAS and SEFAS scales. All patients, after surgery, reported reduced pain. Conclusions: The use of a silicone prosthesis in the surgical treatment of degenerative changes in the MTPI joint, with appropriate indications and excluding cases with large hallux valgus, gives better results than arthrodesis.

Arthrodesis of the first metatarsophalangeal joint using an intraosseous fixation device.

The complication rate for an arthrodesis of the first metatarsophalangeal joint remains high. To improve results, we used a complete intraosseous fixation device (IOFIX) with proposed biomechanical advantages. Our hypothesis is that this technique has at least an equal union rate and less hardware irritation compared to other techniques. Seventy procedures were performed in 55 patients. Average follow-up was 24.5 months. All patients returned to follow-up after 6 weeks and were evaluated for union. Fifty-nine feet (84%) completed full follow- up. Union occurred in 62 of 70 feet (88.5%). Eight feet had nonunion at 1 year follow-up. Average time to fusion was 51 days. Three of 59 feet had malunion. No hardware removal was necessary. In conclusion, an MTP1 arthrodesis using IOFIX provides consistent and good functional outcomes. Due to the low-profile design, no hardware removal was necessary. However, union rates seem slightly lower compared to other techniques.

Factors Influencing the Nonunion Rate Following First Metatarsophalangeal Joint Arthrodesis

Category:Midfoot/ForefootIntroduction/Purpose:The choice of fixation, biomechanical stability, and hardware density might influence the union after the first metatarsophalangeal (MTP) arthrodesis. This study aimed to assess the influencing factors on the union rate and fixation failure after MTP-1 arthrodesis.Methods:In this retrospective cohort study, we included 359 patients with 378 feet from the practice of two foot and ankle surgeons. The surgical technique was identical. The providers randomized patients to receive either the locking plate or cross screws, which comprised 187 (50%) plate fixation and 191 (50%) cross screw fixation. Radiographic union was assessed at three months and the final follow-up and was further categorized as symptomatic versus asymptomatic nonunion.Results:Accounting for potential interaction between variables using multivariable logistic analysis, plate fixation (P=0.018), and diabetes (P=0.044) were significantly associated with a higher nonunion rate. At three month follow-up, 15 (8.3%) patients in the locking plate group and 5 (2.5%) patients in the cross screws group showed nonunion. Of 15 nonunion with plate fixation, 6 (40%) underwent a second surgery because of device failure, while none of the screw fixations required a second surgery (P<0.001). In comparison to asymptomatic nonunion, remaining symptomatic at three months follow-up was a significant risk factor for developing a nonunion with possible device failure at the final follow-up requiring intervention.Conclusion:Cross screw fixation is significantly associated with a lower nonunion, device failure, and secondary surgery rate than plate fixation, which might be related to contact surfaces and biomechanical stability. Besides, the cost saving is more with the cross screws than plate and screws. Diabetic patients should be counseled about the higher nonunion rate.

Why and How Often Is Revision Surgery Necessary after First Metatarsophalangeal Joint Arthrodeses? A Cohort of 120 Consecutive Cases

Background: Little is known about the rate and reasons for revision after primary Metatarsophalangeal (MTP1) arthrodesis with the latest implants. While it is commonly assumed that nonunion accounts for most reoperations, we hypothesized that malposition is the leading cause of revision. The aim of this study was to determine the rate and reasons for revision after MTP1 arthrodesis using cup- and cone-reamers and the latest locking plate technology. Method: Between 2015 and 2017, 120 consecutive MTP1 fusions in 114 patients were performed with a low profile, pre-contoured titanium dorsal locking plate and a plantar metatarsophalangeal screw. The rate and reasons for revision within a minimum one-year follow-up period (average 16 months [12 - 26]) after index procedures were documented and analyzed. The revision was defined as any reoperation following the index procedure excluding hardware removal. Results: Seventeen of 120 feet (14%) underwent revision. Four patients developed a nonunion (3.3%) and needed revision, and 11 feet (9%) required revision for painful malposition; insufficient extension and excessive valgus accounted for the majority. Two patients required medial sesamoidectomy. No infection or wound healing problems occurred. Twelve patients requested hardware removal. Conclusions: Nonunion revision rate after MTP1 fusion with the latest locking plate technology is low. The leading cause of revision is malposition followed by nonunion. Excessive valgus and insufficient extension account for most symptomatic malposition. A recommendation of 0 - 10 degrees of valgus in the horizontal plane may contribute to diminishing revision rates; no conclusions could be drawn regarding an optimal position in the sagittal plane.

Outcome of Concomitant First Metatarsophalageal and Tarsometatarsal Arthrodesis for Severe Hallux Valgus

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:Arthrodesis of the first tarsometatarsal (TMT-1) joint is a widely accepted procedure for treatment of hallux valgus (HV) with medial column instability secondary to unstable first ray, midfoot arthritis, and severe or recurrent deformities with high intermetatarsal angles (IMA). Similarly, metatarsophalangeal fusion (MTP-1) has been suggested for severe hallux valgus, metatarsophalangeal arthritis, and severe or recurrent deformities. Prior studies have demonstrated early outcomes in a small sample of patients. This study aimed to evaluate clinical and radiographic outcomes in patients with severe HV who underwent concomitant TMT-1 and MTP-1 arthrodesis for severe HV.Methods:All patients with symptomatic severe HV who failed conservative management and underwent concomitant MTP-1 and TMT-1 arthrodesis between January 2006 to December 2018 were included in our retrospective case series. Patients were operated on by one of three senior foot and ankle surgeons at a single tertiary center. Demographics, clinical outcomes, patient comorbidity information, and radiographic outcomes including baseline hallux valgus angle (HVA), IMA 1-2, hallux valgus interphalangeus angle, distal metatarsal articular angle, and sesamoid station were collected. The primary outcome was reoperation. Secondary outcomes were minor complications (local wound care, use of antibiotics, and skin dehiscence), visual analogue scale (VAS) pain scores, and change in radiographic measurements.Results:From 2006 to 2018, 42 patients (21.4% male, 78.6% female) at an average age of 62.6 years (range 48 to 80) met inclusion. At final average clinical follow up of 28 months, there were a total of 23 reoperations in 35.7% of patients at an average 18.5 months from index surgery (n=15; 1 revision TMT, 2 revision MTP, 1 hallux interphalangeal (IP) fusion, and 11 hardware removal). Minor complications were present in 7.1% of patients (n=3; 3 local wound care, 2 use of antibiotics, and 3 skin dehiscence). Average VAS score preoperatively and postoperatively was 5.5 to 1.9, respectively. Average preoperative HVA and IMA 1-2 angles were 35.6 and 15.3 degrees compared to postoperative angles of 9.0 and 9.3 degrees, respectively.Conclusion:The present study demonstrates concomitant MTP-1 and TMT-1 arthrodesis in cases of HV secondary to medial column instability secondary to unstable first ray, midfoot arthritis, and severe or recurrent deformities with high IMA has a high correction capability and achieved normal HVA as well as normal IMA 1-2 at greater than two years. Concomitant MTP-1 and TMT-1 arthrodesis in patients with severe HV appeared to be safe and clinically successful.

Severe Hallux Valgus Angle Attended With High Incidence of Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Follow-Up Study

The incidence of nonunion after first metatarsophalangeal joint (MTP-1) arthrodesis was found to be high in our clinic. By raising awareness for the problem, making a uniform surgical treatment protocol, banning the commonly used convex-concave reamers, and promoting solely the use of hand instruments to prepare the joint for arthrodesis, we tried to decrease the numbers of nonunion. This prospective cohort study included all patients who underwent MTP-1 fusion between January 2018 and March 2019. Patients were treated according to a standardized protocol, using hand instruments to prepare the joint for fusion. Anthropometric and therapy-related data were collected and compared with an earlier 2015–2016 cohort that was retrospectively assessed. Furthermore, the frequency of nonunion between convex-concave reamers and hand instruments was compared. A total of 53 patients underwent MTP-1 fusion surgery. The incidence of nonunion was 3.8%, significantly lower than the 24.1% in 2015 to 2016 (p = .002). Multivariate regression analysis showed a 7.11 times higher risk of nonunion in 2015 to 2016 compared with 2018 to 2019 (95% confidence interval [CI] 1.55 to 32.55) (p = .012). Furthermore, an increase of 10° in HVA showed a 1.52 risk of occurrence of nonunion (95% CI 1.07 to 2.17) (p = .021). The use of convex/concave reamers was univariately associated with a 3.61 times higher risk of nonunion (95% CI 1.14 to 11.43) (p = .029); however, after correction for preoperative HVA, the preparation method was no longer associated with the occurrence of nonunion (p = .108). Patients suffering from severe hallux valgus had nonunion in 32.1% of cases. Incidence of nonunion after MTP-1 arthrodesis was significantly reduced by raising awareness and by standardizing the treatment protocol. There was no significant difference in nonunion frequency between the methods of joint surface preparation. Severe hallux valgus is prone to nonunion, and more research into this indication for MTP-1 fusion and outcome is needed.

Trends in arthrodeses and total joint replacements in Foot and Ankle surgery in Germany during the past decade—Back to the fusion?

BackgroundThe goal of this study was to analyze trends in Foot and Ankle surgery in Germany during the past ten years. MethodsData of the German Federal Statistical Office from 2008 until 2018 were screened. We focused on the analysis of fusions and total joint replacements. ResultsThe total amount of the surgeries increased (+39.5%). Especially fusions like arthrodesis of the ankle (+31%) and of the MTP-1 joint (+77%) were on the rise. In 2017 60% of ankle arthrodesis were conducted in men, while 69% of MTP-1 arthrodesis were performed in women.The amount of joint replacements showed a decline during the last decade, in TAR (−39%) and in the MTP-1 (−48%).Regarding the patients age while undergoing a TAR, we observed a shift of the peak age group from 65 to 70 years in 2008 towards 55–60 years in 2017. ConclusionOur study represents actual health care reality in Germany and shows a constant increase of ankle arthritis surgeries in the last decade, while there was a massive shift regarding the ratio of TAR in favour of fusion procedures.

Incidence and outcomes of revision surgery after first metatarsophalangeal joint arthrodesis: Multicenter study of 158 cases

IntroductionFirst metatarsophalangeal (MTP1) joint arthrodesis, described as a safe and effective procedure, has complications that may require surgical revision. These complications are rarely studied. The aim of this study was to determine the incidence and outcomes of revision surgery after MT1 arthrodesis. HypothesisThe incidence of surgical revision after MTP1 arthrodesis is not insignificant; however, the outcomes are satisfactory. Materials and methodsIn this multicenter retrospective study between January 2014 and December 2015, 190 forefoot revisions in patients who had previously undergone MTP1 arthrodesis were included by 8 surgeons. There were no exclusion criteria and all patients had at least 1 year of follow-up. Over the same period, 958 primary MTP1 arthrodesis procedures were performed. ResultsThe mean time to revision was 4.6±10.9 years. At a mean follow-up of 20.5±7.4 months, 158 cases were available for analysis in 135 women and 20 men who had a mean age of 67.1±10.5 years. These revision procedures were carried out because of discomfort related to the hardware at the arthrodesis site (n=86, 54%), nonunion (n=22, 14%), malunion (n=13, 8%) metatarsalgia or claw toe (n=18, 11%) and first interphalangeal (IP1) joint disorders (n=13, 8%). The mean postoperative scores were 75±13.9 for the AOFAS and 65±19.6 for the SF36 total. In the nonunion cases, removal of the hardware led to better outcomes than repeating the arthrodesis procedure. Osteotomy in the malunion cases healed successfully. In the cases of IP1 osteoarthritis, secondary arthrodesis or arthroplasty led to good outcomes. DiscussionRelative to published results of primary MTP1 arthrodesis, the outcomes in our series of revision MTP1 arthrodesis surgery cases are practically equivalent, thus considered acceptable. Level of evidenceIV, Retrospective study.

High Incidence of Non-Union Following Arthrodesis of the First Metatarsophalangeal Joint

Background: Non-union is a complication after arthrodesis of the first metatarsophalangeal joint (MTP-1). The reported incidence varies from 0 to 12%. However, we suspected the incidence might be higher in our clinic. The purpose of this study was to determine the incidence of non-union after MTP-1 arthrodesis.Methods: In a retrospective cohort study, all patients that underwent primary MTP-1 arthrodesis between January 2015 and December 2016 were analysed.Results: 89 toes were included among 84 patients. The cohort consisted of 63 females and 26 males with an average age of 60. The incidence of non-union was 23.5%. No significant differences in means of hallux valgus angle (HVA), age, smoking habits, ASA classification, gender, screw length, surgery duration, the number of bony cortices involved in the fixation, position of the screw intersection, fixation technique, articular surface preparation and the attending surgeon were found.Conclusion: The incidence of non-union following MTP-1 arthrodesis is substantially higher compared to previously reported numbers in literature. No cause regarding the latter was identified. In an attempt to reduce the incidence of non-union, we have recently adjusted our treatment protocol and surgery techniques.

First Metatarsophalangeal Joint Arthrodesis: Does the Addition of a Lag Screw to a Dorsal Locking Plate Influence Union Rate and/or Final Alignment after Fusion

First metatarsophalangeal (MTP-1) joint fusion is a reliable method for the correction of various deformities, including hallux valgus and hallux rigidus. Ideal constructs provide high rates of fusion in the desired alignment. The present study examined the union rates and the change in dorsiflexion angle during the follow-up period in patients who had undergone MTP-1 fusion with a dorsal locking plate and a lag screw compared with patients who had undergone fusion with a dorsal locking plate alone. We performed a retrospective review of 99 feet undergoing MTP-1 fusion. The joints were fused using either a dorsal locking plate alone or a lag screw plus a dorsal locking plate. Union was determined radiographically during the follow-up period. Suspected nonunions were confirmed by computed tomography. The dorsiflexion angles were radiographically measured at the first postoperative visit and at the final follow-up visit. Of the 99 feet, 36 (36.4%) were in the lag screw plus dorsal plate group and 63 (63.6%) in the dorsal plate group. The mean follow-up period was 12.9 (range 12 to 33.5) months. The dorsal plate plus lag screw group had a significantly lower change in the mean dorsiflexion angle (0.57° ± 5.01°) during the postoperative period compared with the dorsal plate group (6.73° ± 7.07°). The addition of a lag screw to a dorsal locking plate for MTP-1 arthrodesis might offer improved stability of the joint in the sagittal plane over time compared with a dorsal plate alone.

Radiographic evaluation of first MTP joint arthrodesis for severe hallux valgus: Does the introduction of a lag screw improve union rates and correction of the intermetatarsal angle?

BackgroundFirst metatarsophalangeal (MTP-1) joint fusion is a reliable method for the correction of various deformities including hallux valgus and hallux rigidus. Ideal constructs provide high rates of fusion in desired alignment. The present study examines the union rates, as well as the change in dorsiflexion angle during the follow up period in patients who underwent MTP-1 fusion with a dorsal locking plate and a lag screw, versus patients fused with a dorsal locking plate alone. MethodsThis is a retrospective review of 99 feet undergoing MTP-1 fusion. Joints were fused using either a dorsal locking plate alone or a lag screw plus a dorsal locking plate. Union was determined radiographically during the follow up period. Suspected nonunions were confirmed with CT. Dorsiflexion angles were radiographically measured at first post-operative visit and at final follow up. ResultsThere were 36 patients in the lag screw plus dorsal plate group, and 63 in the dorsal plate group. Mean follow up was 12.9 months (Range: 12–33.5 months). The dorsal plate plus lag screw group had a significantly lower change in mean dorsiflexion angle (0.57°±5.01°) during the post-operative period compared to the dorsal plate group at final follow up versus the dorsal plate group (6.73°±7.07°). ConclusionThe addition of a lag screw to a dorsal locking plate for MTP-1 arthrodesis may offer improved stability of the joint in the sagittal plane over time compared to a dorsal plate alone. Level of evidenceRetrospective level III evidence.

Bone-block arthrodesis procedure in failures of first metatarsophalangeal joint replacement.

The treatment for the failure of a first metatarsophalangeal joint (MTP1) prosthesis can be complex. There is no consensus regarding the ideal treatment. One of the main issues is the available bone stock after prosthesis removal. The aim of the study was to report the clinical and radiographic results for MTP1 arthrodesis with autologous calcaneus bone graft (bone-block fusion) as a revision procedure of a previous MTP1 implant failure. This study included 12 patients diagnosed with failure of a MTP1 prosthesis. All patients were treated with MTP1 arthrodesis using ipsilateral calcaneal bone graft. Patients were evaluated with the Foot Ankle Disability Index (FADI), the visual analogue pain scale (VAS) and AOFAS Hallux Metatarsophalangeal Interphalangeal scoring system (AOFAS-HMI), weight-bearing radiograph of the foot, and a computed tomography scan. The 1-2 intermetatarsal angle, hallux valgus angle, and first ray length were measured before surgery and at final follow-up. Complications included 3 cases of arthrodesis nonunion, (1 symptomatic, 2 asymptomatic) with 2 of the 3 patients experiencing hardware failure and 1 superficial wound infection. The average FADI improved from 41.8 preoperatively to 84.6 at final follow-up (p<0.05); the average VAS improved from 8.5 preoperatively to 2 at final follow-up (p<0,05); the average AOFAS-HMI significantly improved from 50.7 preoperatively to 73.8 at final follow-up (p<0.05). The average length of the bone-block used was 14.3mm (range 11-19mm). The 1-2 intermetatarsal angle decreased from 9.5° preoperatively to 8.4° at final follow-up (p<0.05); hallux valgus angle improved from 19.7° preoperatively to 14.3° at final follow-up (p<0.05). The management of a failed first metatarsophalangeal joint prosthesis remains controversial. Bone-block arthrodesis using ipsilateral calcaneal autograft appears to be a viable option restoring the bone loss, and avoiding hallux shortening. Nonunion is the most frequent complication with 25% of patients affected, but only 1/3 of patients with nonunion were symptomatic and required revision.

Gait Analysis of Foot Compensation After Arthrodesis of the First Metatarsophalangeal Joint

Arthrodesis of the first metatarsophalangeal (MTP1) joint is an intervention often used in patients with severe MTP1 joint osteoarthritis and relieves pain in approximately 80% of these patients. The kinematic effects and compensatory mechanism of the foot for restoring a more normal gait pattern after this intervention are unknown. The aim of this study was to clarify this compensatory mechanism, in which it was hypothesized that the hindfoot and forefoot would be responsible for compensation after an arthrodesis of the MTP1 joint. Gait properties were evaluated in 10 feet of 8 patients with MTP1 arthrodesis and were compared with 21 feet of 12 healthy subjects. Plantar pressures and intersegmental range of motion were measured during gait by using the multisegment Oxford Foot Model. Pre- and postoperative X-rays of the foot and ankle were also evaluated. The MTP1 arthrodesis caused decreased eversion of the hindfoot during midstance, followed by an increased internal rotation of the hindfoot during terminal stance, and ultimately more supination and less adduction of the forefoot during preswing. In addition, MTP1 arthrodesis resulted in a lower pressure time integral beneath the hallux and higher peak pressures beneath the lesser metatarsals. A mean dorsiflexion fusion angle of 30 ± 5.4 degrees was observed in postoperative radiographs. This study demonstrated that the hindfoot and forefoot compensated for the loss of motion of the MTP1 joint after arthrodesis in order to restore a more normal gait pattern. This resulted in a gait in which the rigid hallux was less loaded while the lesser metatarsals endured higher peak pressures. Further studies are needed to investigate whether this observed transfer of load or a preexistent decreased compensatory mechanism of the foot can possibly explain the disappointing results in the minority of the patients who experience persistent complaints after a MTP1 arthrodesis. Level III, comparative series.

Does Arthrodesis of the First Metatarso-Phalangeal Joint Correct the Intermetatarsal M1M2 Angle? Analysis of Continuous Series of 208 Arthrodesis Plate-Osteosyntheses

Category: Midfoot/Forefoot Introduction/Purpose: MTP-1 arthrodesis allows effective correction of both inter-metatarsal M1M2 and M1P1 angles. Undercorrection of wide M1M2 angle after MTP-1 arthrodesis causes persistently wide forefoot, metatarsalgia and unaesthetic gap between first and second toes. In severe deformities, Rippstein recommended supplementary first metatarsal osteotomy or cuneo-metatarsal arthrodesis. The present study sought to investigate correction of inter-metatarsal M1M2 angle after MTP-1 arthrodesis according to aetiology and pre-operative deformity severity. Methods: A prospective continuous series (June 2007- March 2011) included 208 patients: 48% severe hallux valgus and/or osteoarthritis, 18% hallux rigidus, 16% rheumatoid osteoarthritis, 13% revision, 5% hallux varus; mean age, 62.4±9.9 years (19-87 years). All patients were operated on by a single senior surgeon with the same technique: articular surface reaming (cup-ball), osteosynthesis with titanium anatomical plate (Fyxis-Biotech) and the same rehabilitation procedure. Pre- and post-operative hallux positions were analysed on antero-posterior and lateral weightbearing views. M1M2 and M1P1 were measured according to American Orthopaedic Foot and Ankle Society guidelines. Results: Mean follow-up was 18.6±12.4 months; fusion rate, 97%; 5% plate removal. Mean M1P1 angle was 33.8±19.7° (-45° to 67°) preoperatively, and 13.4±5.3° (0-32°) at follow-up; M1M2, 14.2±5.4° (0° to 26°) and 6.5± 2.3° (0-12°) respectively. M1M2 angle was &lt; 15° in 97 patients, 15-19° in 78 and ≥20° in 33 preoperatively, and respectively 5.8±2.1° (0-10°), 6.7±2.2° (0-10°) and 8.1±2.4° (3-12°) at follow-up. No significant differences were observed according to aetiology. M1M2 angle was &gt;10° in only 2 patients (0.9%) associated with cuneometatarsal osteoarthritis. Improvement increased with severity of preoperative M1M2 angle (p &lt; 0.05). However, mean postoperative M1M2 angle in the severe group was nevertheless wider than in the moderate group. Conclusion: MTP1-arthrodesis corrected M1M2 angle even in severe deformity, of whatever aetiology, in agreement with the literature, whereas Rippstein recently recommended supplementary M1 osteotomy or C1M1 arthrodesis for preoperative M1M2 angle &gt;10°. Pydah correlated preoperative and postoperative intermetatarsal angle with a regression line, without recommending any secondary procedure to improve M1M2 angle. In severe increased preoperative M1M2 angle, we do not recommend associating systematic C1M1 arthrodesis or basal metatarsal osteotomy to MTP-1 arthrodesis, but suggest that additional basal metatarsal osteotomy or C1M1 fusion might be required only in exceptional associated degenerative C1M1 joint.

Bone-Block Arthrodesis Procedure in Failures of First Metatarsophalangeal Joint Replacement

Category: Midfoot/Forefoot Introduction/Purpose: The treatment of the failure of the first metatarsophalangeal joint (MTP1) prosthesis can be complex. There is no consensus regarding treatments options. The main issue is the available bone stock.The aim of the study was to report on clinical and radiographic results for MTP1 arthrodesis with autologous bone graft (bone-block fusion) as a revision procedure of a previous MTP1 implant failure. Methods: We enrolled 12 patients who underwent MTP1 prosthesis failures and retrospectively collected data. All the patient underwent removal of the prosthetic implant and simultaneous MTp1 arthrodesis with autologous bone graft, harvested from the ipsilateral calcaneus (minimum follow-up of 24 months). The minimum time period elapsed between the surgical procedure of prosthetic implant and the revision surgery has been 18 months. Patients were evaluated preoperatively with a weight-bearing radiograph of the foot and CT-scan and at 24 months after surgery with Foot Ankle Disability Index (FADI). Results: The reasons for implant-failures were: 8 mobilization and 4 malalignment. The average defect filled with bone-block was 12.2 mm. The fusion was performed with a plate and locking-screws. We had 3 cases of asymptomatic nonunion at the falangeal side of the fusion, none on the other side. Mean average rate of consolidation in other patients was 10 weeks. All patients returned to common activities’ of daily living. Average FADI was foun1d to be 84.6 at final follow-up. Conclusion: The management of this pathology is still controversial. Bone-block MTP1 arthrodesis The main limitation of the study is the small sample. seems to be a viable option.

Combination of First Metatarsophalangeal Joint Arthrodesis and Proximal Correction for Severe Hallux Valgus Deformity

Arthrodesis of the first metatarso-phalangeal (MTP-1) joint is a widely accepted procedure for the treatment of hallux valgus in patients with MTP-1 degeneration, severe or recurrent deformity, or inflammatory arthritis. This study aimed to evaluate if an additional more proximal correction was beneficial in cases with a severely increased intermetatarsal 1-2 angle (IMA 1-2). A consecutive series of 18 feet (4 bilateral, all females; mean age, 61 years) with severe hallux valgus and an increased IMA 1-2 treated by MTP-1 fusion and an additional more proximal correction (Mau osteotomy or modified Lapidus procedure) was evaluated. Radiographs were analyzed for IMA 1-2 and hallux valgus angles (HVA), and for the position of the tibial sesamoid according to the AOFAS guidelines. At a mean followup of 14 months, all patients were satisfied or very satisfied with the results of surgery. There were no intraoperative complications. The IMA 1-2 significantly improved from a mean of 18.8 degrees before surgery to 4.6 degrees at followup (p < 0.001) and the HVA from a mean of 49.9 degrees to 9.7 degrees (p < 0.001), respectively. Sesamoid position improved two grades on average. We found no difference between the Mau osteotomy and the modified Lapidus procedure. The present results indicate that the combination of a more proximal procedure with a MTP-1 arthrodesis in cases of hallux valgus with severely increased IMA 1-2 has a high correction capability and achieved normal HVAs as well as normal IMAs 1-2. This technique appeared to be safe and clinically successful.