OUTCOME OF BONE BLOCK ARTHRODESIS AS SALVAGE FOR FAILED HALLUX METATARSOPHALANGEAL JOINT SURGERY.

Abstract

Introduction: Management of surgical failures of 1st MTP joint is complex. We present a series of 9 patients treated with bone block arthrodesis of the 1st MTP joint.

Materials and Methods: 9 patients who underwent bone block arthrodesis of the hallux MTP joint over a three year period were retrospectively identified. Most of the patients had failed fusions and kellers arthroplasty. All 9 patients had pain and deformity of the hallux, 8 patients had limitation of mobility and 6 patients had gait and shoe wear problems. All patients underwent 1st MTP arthrodesis with interpositional tricortical bone blocks, to restore 1st ray length, with additional cancellous bone graft used in three patients. The construct was held with K-wires which were buried under the skin. 3 patients were put in plaster postoperatively.

Results: The average age of the patients was 59 years with average follow up of 15 months. The hallux MTP score postoperatively was 78 out of the possible 90. The 1st MTP joint angle improved from 29.17 to 15.33. All the nine patients were satisfied (four rated it excellent and five rated it good) with their outcome, of which six would readily undergo similar operation and three would undergo the operation if there was no other option. Postoperative complications were mostly metalware related with 8 patients having shoe wear problems for which they underwent K-wire removal (usually under a local anaesthetic in the clinic). 4 patients had minor paraesthesia, 3 patients had superficial infection treated with antibiotics and 1 patient had persistent non-union (but was pain free).

Conclusion: The results with bone block arthrodesis are satisfactory and have added advantage of restoring the length of the 1st ray.