Complication rates in diabetics with first metatarsophalangeal joint arthrodesis

Abstract

BackgroundFirst metatarsophalangeal joint (MTPJ) arthrodesis has been an effective surgical entity when indicated, but a range of severe to mild complications can occur from this procedure. Patients with diabetes mellitus have an increased risk in surgical complications, most commonly associated with soft tissue and bone healing, when compared to non-diabetic patients. The purpose of this study was to evaluate the complication rates of first MTPJ arthrodesis in diabetic patients and compare them to the existing complication rates for the procedure.MethodsA retrospective chart review was done on 76 diabetic patients, from June 2002 to August 2012. Thirty-two males and 44 females were included in the study. The authors evaluated many variables that could impact postoperative complications, including age, gender, bone graft incorporation, hemoglobin A1c, tobacco use, body mass index, peripheral neuropathy, hallux extensus, hallux interphalangeal arthritis, and rheumatoid arthritis, and compared them with the complication findings. Patient follow-up was no less than 24 months.ResultsOverall, approximately two-thirds of the patients had no complications and 35.5% of patients had at least one mild or moderate complication. Of the non-union and mal-union complications, 80 and 70% had peripheral neuropathy, respectively. One hundred percent of the patients that had mal-positions or hardware failure also had peripheral neuropathy. No severe complications were seen during follow-up. Only two of the moderate complications needed revisions, and the rest of those with moderate complications were asymptomatic.ConclusionIn conclusion, first MTPJ arthrodesis is overall an effective and beneficial procedure in patients with diabetes mellitus. Diabetic patients with peripheral neuropathy have an increased risk for mild and moderate complications.

Arthrodesis of the first metatarsophalangeal joint: The “when and how”

“…68% of the study’s diabetic patients with peripheral neuropathy had one or more mild to moderate complications (wound dehiscence, infection, delayed or no bone healing). This is significantly higher than the results of non-diabetic patients who had approximately 10% of complications[ 42 ].…”

“…The authors reported that there was no statistically significant difference in the complications rate and the postoperative pain level (AOFAS score: 35.6 ± 6.5 in the Scarf group and 34.5 ± 5.9 in the MTP arthrodesis group) between the two groups. The overall satisfaction rate was similar to the Scarf and the MTP arthrodesis groups, with 91.4% vs 90% of very satisfied or satisfied patients respectively, but when the authors utilized more function specific evaluation tools such as SF 36-a general quality of life score-, the Foot Function Index, and the Foot and Ankle Ability Measure[ 42 ], they found a statistically significant difference favoring MTP arthrodesis[ 45 ]. The issues arising from the later report are those of a study that was solely based on a postoperative questionnaire with no pre-operative scores available, as well as that the leading pathologies in the two groups were not completely similar.…”

“…A rather common metabolic pathology that may complicate the outcome is diabetes mellitus. Anderson et al [ 42 ] reported that although first MTP arthrodesis is overall an effective and beneficial procedure in patients with diabetes mellitus, those with peripheral neuropathy have an increased risk for mild and moderate complications. 35.5% of the study’s diabetic patients had one or more mild to moderate complications but only a small number of those required revision surgery.…”

Development and Characterization of Oxidatively Responsive Thiol–Ene Networks for Bone Graft Applications

“…Type II diabetes (T2D) affects up to 21 million people in the United States, and continues to increase each year . In addition to the cardiovascular impact that T2D has on patients, there are significant musculoskeletal system changes. − Specifically, patients with T2D have a decreased ability to heal after a bone fracture or reconstructive surgery. , Delayed healing or nonunion can be attributed to several factors, such as increased reactive oxygen species (ROS), which promote osteoclastic activity over osteoblastic activity …”

“…Current bone grafting techniques utilize either allografts, demineralized bone matrix, or ceramic-based pastes to serve as a filler and promote fusions. These bone graft options have demonstrated clinical success in the foot with open base wedge procedures. , However, currently available grafts are not well suited for salvage surgery in patients with neuropathic comorbidities, and they achieve sub-optimal results. , Low levels of graft incorporation may be attributed to the failure of the grafts to influence pathophysiology. To this end, there is a need for a clinically relevant bone graft to promote bone fusions in patients with T2D.…”