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. 2023 Apr;143(4):1799-1807.
doi: 10.1007/s00402-022-04342-3. Epub 2022 Jan 29.

High complication rates following revision first metatarsophalangeal joint arthrodesis: a retrospective analysis of 79 cases

Dan Prat  1   2 , Brandon A Haghverdian  3 , Eric M Pridgen  3 , Wonyong Lee  3 , Keith L Wapner  3 , Wen Chao  3 , Daniel C Farber  3
Affiliations

High complication rates following revision first metatarsophalangeal joint arthrodesis: a retrospective analysis of 79 cases

Dan Prat et al. Arch Orthop Trauma Surg. 2023 Apr.

Abstract

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

Methods: A retrospective review of revision MTPJ 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 preoperatively and postoperatively. A multivariate analysis was utilized to determine risk factors for complications and reoperations.

Results: This study yielded a total of 79 cases of revision MTPJ arthrodesis. The mean follow-up time was 365 days (SD ± 295). The overall complication rate was 40.5%, of which the overall nonunion rate was 19.0%. Seven cases (8.9%) required further revision surgery. The multivariate analysis revealed that Diabetes mellitus was associated with significantly higher overall complication rates (p = 0.016), and nonunion was associated with "in-situ" joint preparation techniques (p = 0.042). Visual Analog Scale (VAS) significantly improved postoperatively (p < 0.001); However, PROMIS-10 physical health and PROMIS-10 mental health did not change significantly during the study period.

Conclusion: Treatment of MTPJ surgery failures is a clinical challenge in orthopedic surgery. In our study, revision of first MTPJ surgery resulted in higher nonunion rates and overall complication rates compared to typical outcomes from primary MTPJ arthrodesis. Diabetes, Tobacco use, and "in-situ" joint preparation technique were found to be independent risk factors for complications and reoperations.

Level of evidence: III-Retrospective Cohort Study.

Keywords: Arthrodesis; Complication; Fusion; MTP; Metatarsophalangeal; Nonunion; Revision; Salvage.

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