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Clinical and radiological outcomes after arthrodesis of the first metatarsophalangeal joint

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Abstract

Purpose

The main aim of this study was to investigate the correlation between radiographic findings and clinical outcomes following the first metatarsophalangeal (MTP) joint arthrodesis.

Methods

In a comparative retrospective study, on 46 patients (48 ft), the correlation between post-operative radiographic findings including hallux valgus angle (HVA) and first MTP dorsiflexion angle (MTPDA) and clinical outcomes including VAS pain, modified AOFAS hallux score, and FFI questionnaire were evaluated. Moreover, clinical outcomes were compared between cases with pre-operative diagnosis of first MTP inflammatory arthritis, hallux valgus, hallux varus, and grade 3 and 4 of hallux rigidus. The effect of first MTP arthrodesis on Meary’s angle and intermetatarsal angle (IMA) were found out.

Results

The mean age of the patients was 56.3 ± 9.1 (range, 29–69) years, including 42 (91.3%) females and 4 (8.7%) males. We had fusion rate of 97.9%, one asymptomatic nonunion case (2.1%). Totally, mean scores of modified AOFAS hallux score, FFI percentage, and VAS pain were 88.9 ± 12.6, 9.4 ± 16.5, and 1.23 ± 2.24, respectively. Hallux varus was associated with the most favourable outcomes; whereas, patients with first MTP arthritis got the worst outcome. Regression analysis test between clinical outcomes and HVA > 15° and first MTPDA >15° showed correlation coefficient of almost zero. No statistically significant differences were found between the clinical outcomes of grade 3 and 4 of hallux rigidus (p value of modified AOFAS hallux score, FFI percentage, and VAS pain: 0.879, 0.906, and 0.298, respectively). Mean of HVA and IMA reduction in 15 hallux valgus underwent first MTP fusion were 34.4° and 8.4°, respectively. Meary’s angle increased about 4° with statistically significant difference (p value 0.001).

Conclusion

Patients with first MTP fusion > 15° in coronal and transverse plans could have acceptable clinical outcomes. The clinical outcome of first MTP arthrodesis for grade 3 hallux rigidus is comparable with grade 4. First MTP fusion would have positive effect on IMA and Meary’s angle.

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Acknowledgements

The present article was extracted from the thesis with control field no. 20181225190316.0 and grant no. 97-01-01-18677 which was written by Amir Human Hoveidaei for the degree of Doctor of Medicine. The authors would also like to thank Dr. Zahra Bagheri, Dr. Najaf Zare, and the Research Consultation Center (RCC) of Shiraz University of Medical Science in their assistance in statistical analysis of this manuscript.

Funding

The project was financed by Vice Chancellor for Research of the Shiraz University of Medical Science (Grant No. 97-01-01-18677).

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Authors and Affiliations

  1. Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

    Amir Human Hoveidaei & Amirhossein Roshanshad

  2. Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

    Amir Reza Vosoughi

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  1. Amir Human Hoveidaei
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  2. Amirhossein Roshanshad
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  3. Amir Reza Vosoughi
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All the authors as participated in the design of the study, has contributed to the collection of the data, has participated in the writing of the manuscript, and assumes full responsibility for the content of the manuscript.

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Correspondence to Amir Reza Vosoughi.

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Level of evidence: Level III, retrospective comparative series

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Hoveidaei, A.H., Roshanshad, A. & Vosoughi, A.R. Clinical and radiological outcomes after arthrodesis of the first metatarsophalangeal joint. International Orthopaedics (SICOT) 45, 711–719 (2021). https://doi.org/10.1007/s00264-020-04807-3

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