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, requirement for further surgery, lengthening of 1st ray and any post operative complications.
Results
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Patient Demographics – Male: Female = 4:16
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Mean age – 58 years (38-78 years)
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Mean follow up – 35 months (4-94 months).
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Indication for surgery –
Failed arthroplasty 8
Failed fusion 9
Previous Keller's 1
Failed Scarfe Osteotomy 1
Avascular Necrosis 2
Total 21
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Arthrodesis achieved – 18 patients (90%) at 4 months post surgery (2-12 months).
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Mean AOFAS – 45 pre op, 75 post op.
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Lengthening of 1st Ray achieved – 6 mm average (5mm – 10mm)
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Complications – 7 (35%)
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Major – 3 (15%) – 2 non s, 1 varus overcorrection
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Minor – 4 (20%) – 2 superficial infection, 2 painful hardware
Conclusions
Using interposition arthrodesis for the salvage of 1st MTPJ surgery we can achieve in 90% of patients. However, the rate of complications is not low and hardware often causes irritation, requiring removal.
