Complications Rates and Outcomes Following First Metatarsophalangeal Arthrodesis for Hallux Rigidus: Does Age Matter?

• Main Authors: Matthew Lunati, Wesley J. Manz, Samuel D. Maidman BA, Danielle Mignemi ATC, Jason T. Bariteau MD
• Format: Article
• Language: English
• Published: SAGE Publishing 2020-10-01
• Series: Foot & Ankle Orthopaedics
• Online Access: https://doi.org/10.1177/2473011420S00339

Category: Midfoot/Forefoot; Other Introduction/Purpose: Hallux rigidus is one of the most common toe pathologies in patients greater than 50 years old. While first metatarsophalangeal (MTP) arthrodesis is utilized to improve pain and function, older patients are often considered to be higher risk surgical candidates. There are minimal data on outcomes of MTP arthrodesis and no studies comparing outcomes between geriatric and younger patients. Methods: This is a single center, prospective study of all patients who underwent MTP arthrodesis between August 1, 2015 and July 1, 2018. Patient reported-outcomes were assessed utilizing the Short Form Health survey (SF-36), LifeSpace Assessment survey (LSA), and visual analogue scale (VAS) for pain administered preoperatively as well as 6-months and 1-year postoperatively. Baseline characteristics and surgical outcomes were collected from the electronic medical record. All operations were performed by one foot and ankle fellowship-trained orthopedic surgeon. Clinical and patient-reported outcomes were compared between patients <65 years-old and ≥ 65 years-old. Results: Of 143 included patients, 79 were placed in the younger (mean of 56.5 years) and 64 were in the older (mean of 72.0 years) cohorts. Compared to the younger cohort, the older was more predominantly female (95.3% older group, 77.2% younger group, p=0.002). More patients in the older cohort had hypertension (73.4% older group, 50.6% younger group, p=0.005) and coronary artery disease (9.4% older group, 0.0% younger group, p= 0.005). Both age groups had similar postoperative outcomes, including antibiotic therapy for superficial infections, surgical incision and drainage, deep vein thrombosis, deformity recurrence, or revision surgery. No differences were detected in SF-36, LSA, and VAS surveys administered at baseline, 6-months postoperative, or 1-year postoperative between younger and older patients. Conclusion: Despite more comorbidities, older patients have similar rates of postoperative complications and report similar outcomes for pain, function, and mobility following first MTP arthrodesis. These findings support increased implementation of MTP arthrodesis surgery for older patients with hallux rigidus.