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

INTRODUCTION: First 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. HYPOTHESIS: The incidence of surgical revision after MTP1 arthrodesis is not insignificant; however, the outcomes are satisfactory. MATERIALS AND METHODS: In 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. RESULTS: The 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. DISCUSSION: Relative 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 EVIDENCE: IV, Retrospective study

Can Distal First Metatarsal Supination Osteotomy, Varization Osteotomy, or a Combination of Both Improve HV Surgical Outcomes? Preliminary Results of a Multicenter Randomized Control Trial

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The outcomes of Hallux Valgus (HV) surgical treatment are perfectible. First ray dysmorphia in HV appears to incorporate a first metatarsal (M1) hyperpronation and a valgus deviation of M1 distal articular surface. Those could play a role in first ray destabilization and misalignment in HV. However, we do not know whether correction of these deformities could improve HV surgical treatment outcomes. Therefore, we performed a study to assess the impact of M1 distal supination osteotomy, M1 distal varization osteotomy, and combination of both on HV clinical and radiological outcomes. We hypothesized that M1 distal supination osteotomies would improve surgical outcomes in HV. Methods: We conducted an IRB-approved multicenter randomized control trial. HV with an indication for surgical correction were included. HV requiring surgery of the lesser metatarsals were excluded. Feet were randomly divided into 4 groups corresponding to 4 different types of surgery (Figure): 1. Control, classical M1 distal chevron. 2. Supination M1 distal chevron 3. Varization M1 distal chevron 4. Combination of the latter two. Preoperative evaluation and 6-months follow-up were performed. Demographics, AOFAS score, complications, and patient satisfaction (Likert Scale) were collected. On conventional weight-bearing radiographs before and 6 months after surgery, we measured the Hallux Valgus Angle(HVA), the Intemetatarsal Angle(IMA) the Distal Metatarsal Articular Angle(DMAA), the Okuda's M1 head shape classification(from round to angular) and the sesamoid position according to Hardy and Clapham. Normality of different variables was assessed using the Shapiro-Wilk test. Groups were compared using ANOVA for normal and Kruskall Wallis for nonnormal variables. Post-hoc pairwise analyses were performed with Dunn-Bonferoni’s test. Results: 100 HV were included. 8 were lost to follow-up. The Control (n=24), Supination (n=20), Varization (n=26) and Combination (n=22) groups were comparable on age, gender, BMI, and preoperative radiological parameters. At 6 months, there was no difference on AOFAS improvement (p=0.39) and patients satisfaction (p=0.14) whereas there were significant differences on HVA (p 15°) were present in 5 cases in Control (20.8%), and 2 in Varization (7.7%). Asymptomatic Hallux Varus (HVA < 0°) were present in 4 cases in Combination (18.2%), and 1 in Supination (5%). Conclusion: Distal M1 supination osteotomies showed better improvement in radiological parameters without showing clinical benefit. The combination of supination and varization osteotomies could lead to overcorrection while the classic M1 distal chevron could lead to insufficient corrections. Routinely performing a supination osteotomy in HV surgical management may lead to erroneous correction and we recommend an à la carte treatment. These results are preliminary and we recommend more patients and longer follow-up to confirm these findings

Tarsal Tunnel Syndrome: Outcome According to Etiology

Surgical results in tarsal tunnel syndrome are variable, and etiology seems to be a factor. Three possible etiologies can be distinguished. The aim of the present study was to compare surgical results according to etiology. Three continuous retrospective series (45 patients overall) of tarsal tunnel syndrome were compared. Group 1 presented a permanent intra- or extra-tunnel space-occupying compressive structure. Group 2 presented intermittent intra-tunnel venous dilatations. Group 3 comprised idiopathic tarsal tunnel syndrome. The mean follow-up was 3.6 +/- 1.8 years. The main endpoint was subjective postoperative improvement on Likert scale. Group 1 reported greater improvement than groups 2 and 3. Preoperative neuropathy on ultrasound was associated with poorer improvement, which was not the case for neuropathy on electromyography. Surgical treatment of tarsal tunnel syndrome provides better results in etiologies involving structural compression