IOA 2022

Results of Revision First Metatarsophalangeal Joint Arthrodesis: Does the Primary Procedure Impact Outcomes?

Dan Prat 1,2 Brandon Haghverdian 1 Eric Pridgen 1 Wonyong Lee 1 Keith Wapner 1 Wen Chao 1 Daniel Farber 1
1Department of Orthopaedic Surgery, University of Pennsylvania, USA
2Department of Orthopaedic Surgery, Chaim Sheba Medical Center, Israel

Background:
The most common indications for revision of first metatarsophalangeal (MTP) joint arthrodesis are symptomatic failures of prior arthrodesis, failed hallux valgus correction, and failed MTP arthroplasty implants. However, the outcomes of revision MTP arthrodesis have rarely been studied. The purpose of this study was to compare the clinical, radiographic, and patient-reported outcomes of revision MTP arthrodesis following different primary procedures.

Methods:
A retrospective review of revision MTP arthrodesis cases between January 2015 and December 2019 was performed. The radiographic results, patient-reported outcomes, and rates of complications, subsequent revisions, and nonunions, were analyzed and compared between the four primary procedures groups: hallux valgus repair salvage, arthrodesis nonunion, failed arthroplasty, and failed Cartiva® surgery.

Results:
This study yielded a total of 79 cases of revision MTP arthrodesis. The mean follow-up time was 350 days (SD ±306). The overall complication rate was 40.5%, of which the overall nonunion rate was 19.0%, with seven cases (8.9%) requiring further revision surgery. The complication, nonunion, and revision rates were similar between the primary procedure groups. Diabetes mellitus was associated with significantly higher overall complication rates (p=0.016), and nonunion was associated with “in-situ” and “cup-and-cone” joint preparation techniques (p=0.042). Visual Analog Scale (VAS) scores significantly improved in all revision groups (p=0.001), however, PROMIS-10 physical health improved only in the revision of Cartiva® (p=0.007). PROMIS-10 mental health did not change significantly in any study group.

Conclusion:
Treatment of MTP joint surgery failures is a clinical challenge in orthopaedic surgery. In our study, revision of first MTP joint surgery resulted in higher nonunion rates and overall complication rates compared to typical outcomes from primary MTP arthrodesis. Nevertheless, revision rates, complication rates, and patient-reported outcomes were similar between the different revision groups.