Complications of first tarsometatarsal joint arthrodesis

Objective: First tarsometatarsal joint (TMTJ) arthrodesis, also known as Lapidus, is a surgical procedure used to treat severe hallux valgus, associated hypermobility of the first ray, and/or osteoarthritis of the first TMTJ. Despite the high satisfaction rate and high corrective power, this technique is not without complications. This study aimed to report the complications of first TMTJ arthrodesis. Methods: This is a case series of 16 patients treated with first TMTJ arthrodesis. Patients were evaluated based on foot radiographs, clinical alignment of the hallux, and signs and symptoms. Results: Eight patients had either major or minor complications. Three patients had recurrent deformity (1 with associated nonunion), 2 had delayed union, 2 had hardware loosening (1 with associated nonunion), and 1 had wound dehiscence. Conclusion: First TMTJ arthrodesis requires greater care in choosing the surgical technique for the treatment of hallux valgus. In addition, some points should be considered to minimize complications as much as possible. We believe that data are still scarce to provide a concrete basis. Level of Evidence IV; Therapeutic Studies; Case Series.

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Multicenter Early Radiographic Outcomes of Triplanar Tarsometatarsal Arthrodesis With Early Weightbearing

Foot & Ankle International ◽

10.1177/1071100719847700 ◽

2019 ◽

Vol 40 (8) ◽

pp. 955-960 ◽

Cited By ~ 9

Author(s):

Justin J. Ray ◽

Jennifer Koay ◽

Paul D. Dayton ◽

Daniel J. Hatch ◽

Bret Smith ◽

...

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Retrospective Case ◽

Recurrence Rates ◽

Level Of Evidence ◽

Radiographic Outcomes ◽

Valgus Angle ◽

First Ray ◽

Akin Osteotomy

Background:Hallux valgus is a multiplanar deformity of the first ray. Traditional correction methods prioritize the transverse plane, a potential factor resulting in high recurrence rates. Triplanar first tarsometatarsal (TMT) arthrodesis uses a multiplanar approach to correct hallux valgus in all 3 anatomical planes at the apex of the deformity. The purpose of this study was to investigate early radiographic outcomes and complications of triplanar first TMT arthrodesis with early weightbearing.Methods:Radiographs and charts were retrospectively reviewed for 57 patients (62 feet) aged 39.7 ± 18.9 years undergoing triplanar first TMT arthrodesis at 4 institutions between 2015 and 2017. Patients were allowed early full weightbearing in a boot walker. Postoperative radiographs were compared with preoperative radiographs for hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), and lateral round sign. Any complications were recorded.Results:Radiographic results demonstrated significant improvements in IMA (13.6 ± 2.7 degrees to 6.6 ± 1.9 degrees), HVA (24.2 ± 9.3 degrees to 9.7 ± 5.1 degrees), and TSP (5.0 ± 1.3 to 1.9 ± 0.9) from preoperative to final follow-up ( P < .001). Lateral round sign was present in 2 of 62 feet (3.2%) at final follow-up compared with 52 of 62 feet (83.9%) preoperatively. At final follow-up, recurrence was 3.2% (2/62 feet), and the symptomatic nonunion rate was 1.6% (1/62 feet). Two patients required hardware removal, and 2 patients required additional Akin osteotomy.Conclusion:Early radiographic outcomes of triplanar first TMT arthrodesis with early weightbearing were promising with low recurrence rates and maintenance of correction.Level of Evidence:Level IV, retrospective case series.

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Proximal Spherical Metatarsal Osteotomy for the Foot with Severe Hallux Valgus

Foot & Ankle International ◽

10.3113/fai.2008.1025 ◽

2008 ◽

Vol 29 (10) ◽

pp. 1025-1030 ◽

Cited By ~ 16

Author(s):

Yasuhito Tanaka ◽

Yoshinori Takakura ◽

Tsukasa Kumai ◽

Kazuya Sugimoto ◽

Akira Taniguchi ◽

...

Keyword(s):

Hallux Valgus ◽

Plantar Flexion ◽

Case Series ◽

Osteotomy Site ◽

Metatarsal Osteotomy ◽

Retrospective Case ◽

Level Of Evidence ◽

Tarsometatarsal Joint ◽

Combined Operations ◽

Severe Hallux Valgus

Background: A proximal spherical metatarsal osteotomy was devised to correct not only varus deviation of the first metatarsal, but also dorsiflexion. We expected to increase the medial longitudinal arch by adding plantar flexion at the osteotomy site. To investigate the limitations of this procedure for feet with severe hallux valgus, a followup study was performed on patients with preoperative hallux valgus angles greater than or equal to 40 degrees. Materials and Methods: Forty-eight feet in 37 patients (10 male, 27 female) (60 years; range, 20 to 84 years) were investigated. Mean followup was 4 years and 1 month, ranging from 2 to 8 years. The spherical osteotomy was performed using a curved chisel. A distal soft tissue procedure was done at the same time. Twenty feet received combined operations for their combined deformities. Results: While 81% of patients were satisfied with the results, 50% of those with preoperative hallux valgus angles greater than or equal to 50 degrees had postoperative hallux valgus angle greater than or equal to 20 degrees. In these patients, correction of metatarsus primus varus was good, but correction of valgus deviation of the hallux was fair. Mean correction toward plantar flexion was 1.5 degrees and no increase in arch height was achieved. Conclusion: The proximal spherical osteotomy could consistently achieve satisfactory results for the patients with hallux valgus angles less than 50 degrees. However, the corrections were worse in feet with more severe deformities. Furthermore, plantarflexion at the osteotomy site was offset by displacement at the first tarsometatarsal joint. If plantarflexion is indispensable, arthrodesis of the tarsometatarsal joint is recommended. Level of Evidence: IV, Retrospective Case Series

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Effect of the Modified Lapidus Procedure on Pronation of the First Ray in Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100719883325 ◽

2019 ◽

Vol 41 (2) ◽

pp. 125-132 ◽

Cited By ~ 4

Author(s):

Matthew S. Conti ◽

Joseph F. Willett ◽

Jonathan H. Garfinkel ◽

Mark C. Miller ◽

Stephen V. Costigliola ◽

...

Keyword(s):

Hallux Valgus ◽

Computer Aided Design ◽

Case Series ◽

Ct Scans ◽

Level Of Evidence ◽

3 Dimensional ◽

Computed Tomographic ◽

First Metatarsal ◽

Signed Rank ◽

First Ray

Background: Hallux valgus (HV) is a triplanar deformity of the first ray including pronation of the first metatarsal with subluxation of the sesamoids. The purpose of this study was to investigate if a first tarsometatarsal fusion (modified Lapidus technique), without preoperative knowledge of pronation measured on weightbearing computed tomographic (CT) scans, changed pronation of the first metatarsal and determine if reduction of the sesamoids was correlated with changes in first metatarsal pronation. Methods: Thirty-one feet in 31 patients with HV who underwent a modified Lapidus procedure had preoperative and at least 5-month postoperative weightbearing CT scans and radiographs. Differences in preoperative and postoperative pronation of the first metatarsal using a 3-dimensional computer-aided design, HV angle, and intermetatarsal angle (IMA) were calculated using Wilcoxon signed-rank tests. After dividing patients into groups based on sesamoid station, Kruskal-Wallis H tests were used to compare first metatarsal pronation between the groups. Results: The mean preoperative and postoperative pronation of the first metatarsal was 29.0 degrees (range 15.8-51.1, SD 8.7) and 20.2 degrees (range 10.4-32.6, SD 5.4), respectively, which was a mean change in pronation of the first ray of −8.8 degrees ( P < .001). There was no difference in pronation of the first ray when stratified by postoperative sesamoid position ( P > .250). The average preoperative and postoperative IMA was 16.7 degrees (SD 3.2) and 8.8 degrees (SD 2.8), which demonstrated a significant change ( P < .001). Conclusions: The modified Lapidus procedure was an effective tool to change pronation of the first ray. Reduction of the sesamoids was not associated with postoperative first metatarsal pronation. Level of Evidence: Level IV, case series.

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PO 18175 - Complications of first tarsometatarsal joint arthrodesis

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1025 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 36S

Author(s):

Rodrigo Yuzo Masuda ◽

Lucas Furtado da Fonseca ◽

André Vitor Kerber Cavalcante Lemos ◽

Vinicius Felipe Pereira ◽

Caio Augusto De Souza Nery ◽

...

Keyword(s):

Scientific Evidence ◽

Deformity Correction ◽

Wound Dehiscence ◽

Delayed Union ◽

High Rate ◽

School Of Medicine ◽

Implant Positioning ◽

Tarsometatarsal Joint ◽

Surgical Wound Dehiscence ◽

First Ray

Introduction: First tarsometatarsal joint arthrodesis, more commonly known as the Lapidus procedure, is used to treat severe hallux valgus, associated first ray hypermobility and regional osteoarthrosis. Despite its high rate of deformity correction and resolutive power, the technique is not without complications. However, there is little scientific evidence regarding complications after this procedure. Objective: This study aims to record complications associated with first tarsometatarsal joint arthrodesis. Methods: Patients who underwent this arthrodesis procedure, which was performed by different surgeons trained at Paulista School of Medicine, Federal University of São Paulo, were assessed over a series of outpatient follow-up visits. Results: In total, 16 patients operated on in over an 18-month period were evaluated in this study. During this period, 8 patients developed some type of complication, either major or minor. Three patients experienced deformity relapse, one case of which with associated pseudarthrosis; 2 patients had delayed union; 2 patients had hardware loosening, one of whom had associated pseudarthrosis; and one patient had surgical wound dehiscence. In all cases, the procedure was completed using high-quality materials. Discussion: In our literature review, we found various complications, including pseudarthrosis, delayed union, symptomatic hardware, relapse and loss of correction. There are reports in the literature of surgical technique modifications, such as changes in fixation types and implant positioning, to reduce the rate of these complications. However, even with new implants and the evolution of the procedure, this surgery still requires a steep learning curve, and the rate of complications is not small.

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Maintenance of Correction of the Modified Lapidus Procedure With a First Metatarsal to Intermediate Cuneiform Cross-Screw Technique

Foot & Ankle International ◽

10.1177/1071100719895268 ◽

2019 ◽

Vol 41 (4) ◽

pp. 428-436 ◽

Cited By ~ 2

Author(s):

Travis M. Langan ◽

Joseph M. Greschner ◽

Roberto A. Brandão ◽

David A. Goss ◽

Clair N. Smith ◽

...

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Bony Union ◽

Hallux Valgus Angle ◽

Retrospective Case ◽

Level Of Evidence ◽

Intermetatarsal Angle ◽

First Metatarsal ◽

Tarsometatarsal Joint ◽

Valgus Angle

Background: Recurrence of deformity remains a concern when fusing the first tarsometatarsal joint for correction of hallux valgus (HV). A recently described construct adds an additional point of fixation from the plantar medial first metatarsal to the intermediate cuneiform. The purpose of this study was to determine the maintenance of correction of the first and second intermetatarsal angle, hallux valgus angle, and tibial sesamoid position after undergoing a first tarsometatarsal joint arthrodesis using the proposed construct. Methods: A radiographic review was performed of patients with HV treated with a first tarsometatarsal joint arthrodesis with the addition of a cross-screw intermediate cuneiform construct. Three observers reviewed radiographic data, including preoperative weightbearing, first weightbearing, and final weightbearing plain-film radiographs. Initial improvement and maintenance of intermetatarsal angle, hallux valgus angle (HVA), and tibial sesamoid position were evaluated radiographically. A total of 62 patients met inclusion criteria and were included in the study. Mean follow-up time was 9.3 months (SD 6.7). Results: Bony union was achieved in 60 of 62 patients (96.7%). Two of 62 patients required revision surgery as a result of recurrence (3.3%). Final mean improvement of the intermetatarsal angle (IMA) was 6.8 degrees (±2.9 degrees), HVA was 14.8 degrees (±7.5 degrees), and tibial sesamoid position was 2.4 (±1.4) positions. Mean loss of IMA correction was 1.5 degrees (±1.6), HVA was 2.9 degrees (±4.8 degrees), and tibial sesamoid position was 0.8 (±0.8). Conclusion: This study showed that the cross-screw intermediate cuneiform construct for first tarsometatarsal joint arthrodesis had a good union rate, a low complication rate, and maintained radiographic correction. Level of Evidence: Level IV, retrospective case series.

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Modified Minimal Incision Subcapital Osteotomy for Hallux Valgus Correction

Foot & Ankle Specialist ◽

10.1177/1938640012470716 ◽

2013 ◽

Vol 6 (1) ◽

pp. 65-72 ◽

Cited By ~ 14

Author(s):

Andrea Scala ◽

Domenico Vendettuoli

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Rating Scale ◽

Case Series ◽

Invasive Procedure ◽

Delayed Union ◽

Retrospective Case ◽

Level Of Evidence ◽

Minimal Incision ◽

Student’S T

The potential advantages of minimal incision surgery for hallux valgus (HV) correction are the following: reduced surgical exposure, diminished soft-tissue stripping, and less blood supply impairment. These advantages imply fewer complications. We retrospectively reviewed patients who were consecutively treated with a modified minimally invasive osteotomy from January 2006 until December 2009 for HV deformity. We radiographically assessed the HV angle, 1-2 intermetatarsal (IM) angle, and tibial sesamoid position. Clinical outcomes were determined using the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal (AOFAS HMI) Clinical Rating Scale. A paired Student’s t test was used to determine significance, with P < .01. There were 126 patients (146 feet) with an average age of 52.6 years and an average postoperative follow-up of 29.1 months. Preoperatively, the average HV angle was 32.3°, and postoperatively, it was 4.5° (P < .01). The preoperative average IM angle was 14.4°, whereas postoperatively, it was 4.8° (P < .01). The average tibial sesamoid position was 6.3 preoperatively and 2.5 postoperatively (P < .01). The average AOFAS HMI score was 54.6 preoperatively and 85.3 postoperatively (P < .01). There were 15 postoperative complications (10.3%) that included hallux varus, painful hardware, and delayed union. The results are comparable with those of traditional open techniques, with the additional advantages of a minimally invasive procedure. Level of Evidence: Therapeutic, Level IV: Retrospective case series

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First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction

Foot & Ankle International ◽

10.1177/10711007211034516 ◽

2021 ◽

pp. 107110072110345

Author(s):

Chien-Shun Wang ◽

Yun-Hsuan Tzeng ◽

Tzu-Cheng Yang ◽

Chun-Cheng Lin ◽

Ming-Chau Chang ◽

...

Keyword(s):

Risk Factors ◽

Hallux Valgus ◽

Reconstructive Surgery ◽

Case Series ◽

Deformity Correction ◽

Level Of Evidence ◽

Factors Affecting ◽

Radiographic Parameters ◽

Case Series Study ◽

Adult Acquired Flatfoot Deformity

Background: Adult acquired flatfoot deformity (AAFD) and hallux valgus (HV) are common foot and ankle deformities. Few studies have reported the changes in radiographic parameters of HV after reconstructive surgery for AAFD. This study aimed to evaluate the changes in radiographic parameters of HV and analyze the risk factors for increased HV after correction of AAFD. Methods: Adult patients with flexible AAFD who underwent similar bony procedures including medializing calcaneal osteotomy and Cotton osteotomy were included. Radiographic parameters were measured on weightbearing radiographs preoperatively, postoperatively, and at the final follow-up. Patients were divided into hallux valgus angle (HVA) increased and HVA nonincreased groups; logistic regression analysis was performed to identify risk factors affecting increased HV. Results: Forty-six feet of 43 patients were included. After AAFD reconstructive surgery, the tibial sesamoid position improved by 1 grade, but the HVA increased 4 degrees in average. Further, 21 of 46 feet (46%) showed an HVA increase ≥5 degrees immediately after AAFD correction surgery. Preoperative talonavicular coverage angle <21.6 degrees was a risk factor associated with HV increase immediately after the surgery. Conclusion: In this case series, using plain radiographs to measure standard parameters of foot alignment, we found the association between AAFD correction and HV deformity measures somewhat paradoxical. Correction of overpronation of the hindfoot and midfoot appears to improve the first metatarsal rotational deformity but may also increase HVA. A lower preoperative talonavicular coverage angle was associated with an increase of the HVA after surgery. Level of Evidence: Level IV, case series study.

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Exercise-Induced Scalenus Syndrome

The American Journal of Sports Medicine ◽

10.1177/0363546507312166 ◽

2008 ◽

Vol 36 (2) ◽

pp. 369-374 ◽

Cited By ~ 15

Author(s):

Panagiotis Baltopoulos ◽

Charalampos Tsintzos ◽

George Prionas ◽

Maria Tsironi

Keyword(s):

Quality Of Life ◽

Thoracic Outlet Syndrome ◽

Surgical Intervention ◽

Case Series ◽

Signs And Symptoms ◽

Underlying Mechanism ◽

Level Of Evidence ◽

Full Activity ◽

Exercise Induced

Background Thoracic outlet syndrome is described as a group of distinct disorders producing signs and symptoms attributed to compression of nerves and blood vessels in the thoracic outlet region. Purpose To describe the exercise-induced scalenus anticus syndrome attributed to the anterior scalenus hypertrophy as a thoracic outlet syndrome underlying mechanism and to give recommendations for a safe and effective surgical treatment. Study Design Case series; Level of evidence, 4. Methods Twelve young professional athletes admitted for thoracic outlet syndrome (8 cases of neurologic thoracic outlet syndrome, 4 cases of mixed neurologic and vascular thoracic outlet syndrome) who reported numbness, tingling, early fatigue, muscle weakness, and pain were enrolled in the study. Scalenus hypertrophy was suspected to be the causative factor. Scalenectomy was performed in all cases. Results All patients had moderate to severe hypertrophy of the anterior scalenus muscle. Scalenectomy was performed, and there were no intraoperative or postoperative complications. Full activity was quickly achieved, and no recurrence of symptoms was documented. Conclusion Surgical intervention for scalenus anticus syndrome can allow an athlete to return to full activity and improve quality of life. Surgical intervention seems to be the treatment of choice in terms of restoring quality of life and physical activity.

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First-Tarsometatarsal Joint Alignment After First-Metatarsophalangeal Joint Arthrodesis for Hallux Valgus

Foot & Ankle Orthopaedics ◽

10.1177/24730114211008514 ◽

2021 ◽

Vol 6 (2) ◽

pp. 247301142110085

Author(s):

Christopher Traynor ◽

James Jastifer

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Metatarsophalangeal Joint ◽

Retrospective Case ◽

Level Of Evidence ◽

First Metatarsophalangeal Joint ◽

First Metatarsal ◽

Metatarsal Angle ◽

Medial Cuneiform ◽

Radiographic Alignment

Background: Instability of the first-tarsometatarsal (TMT) joint has been proposed as a cause of hallux valgus. Although there is literature demonstrating how first-TMT arthrodesis affects hallux valgus, there is little published on how correction of hallux valgus affects the first-TMT joint alignment. The purpose of this study was to determine if correction of hallux valgus impacts the first-TMT alignment and congruency. Improvement in alignment would provide evidence that hallux valgus contributes to first-TMT instability. Our hypothesis was that correcting hallux valgus angle (HVA) would have no effect on the first-TMT alignment and congruency. Methods: Radiographs of patients who underwent first-MTP joint arthrodesis for hallux valgus were retrospectively reviewed. The HVA, 1-2 intermetatarsal angle (IMA), first metatarsal–medial cuneiform angle (1MCA), medial cuneiform–first metatarsal angle (MC1A), relative cuneiform slope (RCS), and distal medial cuneiform angle (DMCA) were measured and recorded for all patients preoperatively and postoperatively. Results: Of the 76 feet that met inclusion criteria, radiographic improvements were noted in HVA (23.6 degrees, P < .0001), 1-2 IMA (6.2 degrees, P < .0001), 1MCA (6.4 degrees, P < .0001), MC1A (6.5 degrees, P < .0001), and RCS (3.3 degrees, P = .001) comparing preoperative and postoperative radiographs. There was no difference noted with DMCA measurements (0.5 degrees, P = .53). Conclusion: Our findings indicate that the radiographic alignment and subluxation of the first-TMT joint will reduce with isolated treatment of the first-MTP joint. Evidence suggests that change in the HVA can affect radiographic alignment and subluxation of the first-TMT joint. Level of Evidence: Level IV, retrospective case series.

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Loss of Correction After Chevron Osteotomy for Hallux Valgus as a Function of Preoperative Deformity

Foot & Ankle International ◽

10.1177/1071100718807699 ◽

2018 ◽

Vol 40 (3) ◽

pp. 287-296 ◽

Cited By ~ 8

Author(s):

Gerhard Kaufmann ◽

Stefanie Sinz ◽

Johannes M. Giesinger ◽

Matthias Braito ◽

Rainer Biedermann ◽

...

Keyword(s):

Hallux Valgus ◽

Case Series ◽

X Rays ◽

Retrospective Case ◽

Level Of Evidence ◽

Loss Of Correction ◽

Chevron Osteotomy ◽

Significant Correction ◽

Preoperative Deformity

Background: Recurrence is relatively common after surgical correction of hallux valgus. Multiple factors are discussed that could have an influence in the loss of correction. The aim of this study was to determine preoperative radiological factors with an influence on loss of correction after distal chevron osteotomy for hallux valgus. Methods: Five hundred twenty-four patients who underwent the correction of a hallux valgus by means of distal chevron osteotomy at our institution between 2002 and 2012 were included. We assessed weightbearing x-rays at 4 time points: preoperatively, postoperatively, and after 6 weeks and 3 months. We investigated the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), joint congruity, and the position of the sesamoids. Results: At all points of the survey, significant correction of the IMA and HVA was detected. The IMA improved from 12.9 (± 2.8) to 4.5 (± 2.4) degrees and the HVA from 27.5 (± 6.9) to 9.1 (± 5.3) degrees. Loss of correction was found in both HVA and IMA during follow-up with a mean of 4.5 and 1.9 degrees, respectively. Loss of correction showed a linear correlation with preoperative IMA and HVA, and a correlation between preoperative DMAA and sesamoid position. Conclusion: The chevron osteotomy showed significant correction for HVA, IMA, and DMAA. Preoperative deformity, in terms of IMA, HVA, DMAA, and sesamoid position, correlated with the loss of correction and could be assessed preoperatively for HVA and IMA. Loss of correction at 3 months persisted during the follow-up period. Level of Evidence: Level IV, retrospective case series.

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