Abstract
Background
Salvage procedures on the 1st MTPJ following failed arthroplasty, arthrodesis or hallux valgus surgery are difficult and complicated by bone loss. This results in shortened first ray and transfer metatarsalgia. We present our experience of using tri-cortical interposition grafts to manage this challenging problem.
Methods
Between 2002 and 2009 our department performed 21 1st MTPJ arthrodeses using a tri-cortical iliac crest interposition graft. Surgical fixation was achieved with a compact foot plate. We performed a retrospective review from the medical notes and radiographs along with American Foot and Ankle scores which were collected prospectively.
We analysed the following parameters: time to radiological union, requirement for further surgery, lengthening of 1st ray and any post operative complications.
Results
Patient demographics were Male: Female = 4:16 with a mean age of 58 years (38-78 years). Mean follow up was 35 months (4-94 months). Indications for surgery were failed arthroplasty 8, failed fusion 9, previous Keller's 1, failed Scarfe Osteotomy 1 and avascular necrosis 2. Arthrodesis was achieved in 18 patients (90%) at 4 months post-surgery (2-12 months). Mean AOFAS was 45 pre-op, 75 post-op. Lengthening of the 1st Ray was achieved with 6mm average (5mm - 10mm). There were 7 complications (35%), with 3 major (15%) – 2 non unions and 1 varus overcorrection and 4 minor (20%) – 2 superficial infection, 2 painful hardware.
Conclusion
Using interposition arthrodesis for the salvage of 1st MTPJ surgery we achieved union in 90% of patients. However, the rate of complications is not low and hardware often causes irritation, requiring removal.
