Download - Radiographic Analysis of Metatarsophalangeal joint Arthrodesis for Hallux Valgus Deformity
Radiographic Outcomes Following Primary Arthrodesis of the First Metatarsophalangeal Joint in Hallux Abductovalgus Deformity• Presenter: Wenjay Sung, DPM
• Authors: Wenjay Sung DPM, Patrick R. Burns, DPM, and Dane K. Wukich, MD
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Radiographic Outcomes Following Primary Arthrodesis of the First Metatarsophalangeal
Joint in Hallux Abductovalgus Deformity
Wenjay Sung, DPM
My disclosure is in the Final AOFAS Program Book. I have no potential conflicts with this
presentation.
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Purpose
• Evaluate radiographic outcomes of primary 1st MTPJ arthrodesis – For hallux abductovalgus
• Effect on deformities based upon magnitude• Correlate the effect of the procedure using a relatively larger
spectrum of data.
– Determine usefulness in correction of commonly utilized radiographic measurements
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Methods
• IRB approval obtained– March 2004 – January
2009– 115 records– Excluding:
• Previous 1st ray surgeries• Incomplete medical records• Hallux varus deformity• Did not meet hallux valgus
deformity criteria (Coughlin)
– 58 feet (56 patients)
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Methods
• Procedure– Conical reamers– Rigid internal fixation
• Post-operative– 10-14 days in splint– WBAT in rigid boot or
shoe– Radiographs at each
follow-up for at least 3 months post-surgery
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Methods
• Measurements– Primary radiographic
measurements• Pre-operative versus post-
operative– Hallux Valgus angle (HA)– 1st-2nd Intermetatarsal
angle (IM)– Secondary radiographic
measurements• Presence of pre-operative 1st
MTPJ arthritis
• Groups– Divided by IM severity
• Mild, moderate, severe
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Statistical Analysis
• Using SPSS version 14.0 (SPSS Science Inc, Chicago, IL) – Descriptive and
Inferential Statistics Calculated
• A two-way repeated measures analysis of variance (ANOVA)
• Pre-op and post-op outcomes
• For 3 different groups
– A one-way ANOVA• Compare differences
between groups
– The a priori level was 0.05 for all statistical tests.
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Results
• Overall (N = 58)• Median length of follow-up 12 months
– (mean 17.7 months, range 3 – 68 months)
• Patient demographics– 45 of 56 patient were female– 32 of 58 procedures were on right foot
• Union rate of 94.8% (55 of 58 joints) – Average HA correction = 18.50
• P < 0.01
– Average IM correction = 4.20
• P < 0.01
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Results
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Results
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Results
• Further analysis– Significant incremental post-operative
correction with increasing deformity for 1st- 2nd intermetatarsal angle
• Mild vs Severe (P < 0.01)• Moderate vs Severe (P < 0.05)
– No significant difference in post-op hallux valgus angle amongst groups
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Post-operative angle correction
0
5
10
15
20
25
30
Mild Moderate Severe
HA correction
IM correction
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Discussion
• Limitations– Retrospective design
• Assessor bias • Measurement bias• Non responder bias• Our minimum follow up of three months may be considered
less than ideal
– No control group
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Discussion
• The mean HA and IM decreased significantly – HA 31.90 to 13.40 (P < 0.01)– IM 14.00 to 9.70 (P < 0.01)
• Primary first MTPJ arthrodesis is not commonly associated with mild hallux abductovalgus correction without degenerative changes.
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Conclusion
• The amount of postoperative radiographic correction after MTPJ arthrodesis improves correspondingly. – Higher amounts of correction are achieved in
deformities with the most severe preoperative angular measurements