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Arthroscopic Arthrodesis of the First Metatarsophalangeal Joint in Hallux Varus

ABSTRACT: Hallux varus deformity most commonly occurs as a complication of bunion surgery. Surgical option depends on the underlying cause, flexibility of the deformity, and presence of osteoarthritis of the first metatarsophalangeal joint. Joint-preserving surgery including medial soft tissue release, metatarsal osteotomy, and tendon transfer can be considered in flexible deformity without degeneration of the first metatarsophalangeal joint. First metatarsophalangeal arthrodesis is indicated in cases of inflammatory arthritis, avascular necrosis, osteoarthritis, neuromuscular disorder, or failed previous hallux varus corrective surgery. The purpose of this technical note is to describe the technique of arthroscopic arthrodesis of the first metatarsophalangeal joint to correct hallux varus deformity. It has the potential advantages of less surgical trauma, preservation of blood supply, less postoperative pain, and better cosmetic results. Technique Video Video 1 Arthroscopic arthrodesis of the first metatarsophalangeal joint in hallux varus of the right foot. The patient is in supine position with the legs spread. The abductor hallucis tendon and medial capsule of the first metatarsophalangeal joint is released via the proximal plantar medial incision. With the medial portal as the viewing portal and the dorsolateral portal as the working portal, the articular cartilage of the base of proximal phalanx and the metatarsal head is removed with an arthroscopic shaver and the subchondral bone is microfractured with an arthroscopic awl. Tourniquet is released to observe for bleeding from the microfracture holes. The first metatarsophalangeal joint is then reduced to 20° dorsiflexion and fixed with two 4.0 mm cannulated screws under fluoroscopic guide.

SUBMITTER: Li C

PROVIDER: S-EPMC8626559 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundArthrodesis of the first metatarsophalangeal joint is the current treatment of choice for symptomatic advanced hallux rigidus and moderate-to-severe hallux valgus. There are different methods to perform arthrodesis, yet no consensus on the best approach. Therefore, this study aimed to determine the effects of preoperative and postoperative hallux valgus angle (HVA), joint preparation and fixation technique, and postoperative immobilization on the incidence of nonunion.MethodsA retrospective multicenter cohort study was performed that included 794 patients. Univariate and multiple logistic regression was conducted to determine associations between joint preparation, fixation techniques, postoperative immobilization, weightbearing, and pre- and postoperative HVA with nonunion.ResultsNonunion incidence was 15.2%, with 11.1% symptomatic and revised. Joint preparation using hand instruments (OR 3.75, CI 1.90-7.42) and convex/concave reamers (OR 2.80, CI 1.52-5.16) were associated with greater odds of a nonunion compared to planar cuts. Joint fixation with crossed screws was associated with greater odds of nonunion (OR 2.00, CI 1.11-3.42), as was greater preoperative HVA (OR 1.02, CI 1.00-1.03). However, the latter effect disappeared after inclusion of postoperative HVA in the model, with a small association identified between residual postoperative HVA and nonunion (OR 1.04, CI 1.01-1.08). Similarly, we found an association between odds of nonunion and higher body weight (OR 1.02, CI 1.01-1.04) but not of body mass index.ConclusionBased on our results, first metatarsophalangeal joint arthrodesis with planar cuts and fixation with a plate and interfragmentary screw is associated with the lowest odds of resulting in a nonunion. Higher body weight and greater preoperative HVA were associated with slight increase in rates of nonunion. It is crucial to properly correct the hallux valgus deformity during surgery.Level of evidenceLevel III, retrospective case control study.

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Arthroscopic Arthrodesis of the First Metatarsophalangeal Joint in Hallux Varus

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