Effect of Age on Complication Rates and Outcomes Following First Metatarsophalangeal Arthrodesis for Hallux Rigidus

Lunati, Matthew P.; Manz, Wesley J.; Maidman, Samuel D.; Kukowski, Nathan; Mignemi, Danielle; Bariteau, Jason T.

doi:10.1177/1071100720942140

Cited by 14 publications

(7 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a quite similar study with a much shorter follow-up (1 year postoperatively), no difference in pain and function was found between young and old patients. 23 The main difference for this discrepancy with our study we see in the age cutoff, with young patients defined as age ≤65 years, for us up to 50 years, but also the follow-up time and the other clinical scores might have had an influence (ie, 36-Item Short Form Health Survey [SF-36] and Life-Space Assessment survey [LSA]). Another study showed that in young patients (mean age 49 years), 96% (n = 48/50) were satisfied with their level of sports activity after 1-2 years following MTP I arthrodesis.…”

Section: Discussioncontrasting

confidence: 56%

Ten-Year Minimum Follow-up Study of First Metatarsophalangeal Joint Fusion in Young vs Old Patients

Scheurer,

Zimmermann,

Fischer

et al. 2023

Foot Ankle Int.

View full text Add to dashboard Cite

Background: Painful degenerative joint disease (DJD) of the first metatarsophalangeal joint (MTP I), or hallux rigidus, mainly occurs in later stages of life. For end-stage hallux rigidus, MTP I arthrodesis is considered the gold standard. As young and active patients are affected considerably less frequently, it currently remains unclear, whether they benefit to the same extent. We hypothesized that MTP I arthrodesis in younger patients would lead to an inferior outcome with decreased rates of overall with lower rates of patient postoperative pain and function compared to an older cohort. Methods: All patients aged <50 y ears who underwent MTP I arthrodesis at our institution between 1995 and 2012 were included in this study. This group was then matched and compared with a group of patients aged >60 years. Minimum follow-up was 10 years. Outcome measures were Tegner activity score (TAS), a “Virtual Tegner activity score” (VTAS), the visual analog scale (VAS), and the Foot Function index (FFI). Results: Sixty-one MTP I fusions (n = 28 young, n = 33 old) in 46 patients were included in our study at an average of 14 years after surgery. Younger patients experienced significantly more pain relief as reflected by changes in VAS and FFI Pain subscale scores. No difference in functional outcomes was found with change in the FFI function subscale or in the ability to have desired functional outcomes using the ratio of TAS to VTAS. Revision rate did not differ between the two groups apart from hardware removal, which was significantly more likely in the younger group. Conclusion: In patients below the age of 50 years with end-stage DJD of the first metatarsal joint, MTP I arthrodesis not only yielded highly satisfactory postoperative results at least equal outcome compared to an older cohort of patients aged >60 years at an average 14 years’ follow-up. Based on these findings, we consider first metatarsal joint fusion even for young patients is a valid option to treat end-stage hallux rigidus. Level of Evidence: Level III, a case-control study.

show abstract

Section: Discussioncontrasting

confidence: 56%

Ten-Year Minimum Follow-up Study of First Metatarsophalangeal Joint Fusion in Young vs Old Patients

Scheurer,

Zimmermann,

Fischer

et al. 2023

Foot Ankle Int.

View full text Add to dashboard Cite

show abstract

“…In the same vein, Vermersch et al 39 found that older patients did not have an increased rate of delayed healing, deep infections, and nonunion after forefoot surgery. Lunati et al 20 also reported that patients aged ≥65 years old and those younger than 65 years had similar rates of postoperative wound complications, deep vein thrombosis, or reoperations for complications after metatarsophalangeal arthrodesis for hallux rigidus, although the older group had a greater number of comorbidities. Overall, these findings suggest that increasing age had little influence on the perioperative outcomes of hallux valgus surgery, likely owing to the low surgical morbidity of the procedure.…”

Section: Discussionmentioning

confidence: 97%

Effect of Age on Clinical and Radiological Outcomes of Hallux Valgus Surgery

et al. 2021

View full text Add to dashboard Cite

Background: The prevalence of hallux valgus increases with age. However, no studies have compared the effectiveness of surgical correction among different age groups. This study investigated the influence of age on clinical and radiological outcomes following hallux valgus surgery. Methods: Patients who underwent correction for hallux valgus at an academic hospital were stratified into 3 age groups: younger (<50 years), middle-aged (50-59 years), and older (≥60 years). Functional outcomes and satisfaction questionnaires were collected preoperatively and at 6 months and 2 years postoperatively. Radiological recurrence and reoperations were recorded at follow-up. There were 193 patients (93% female): 34 younger, 74 middle-aged, and 85 older. Results: The preoperative hallux valgus angle was significantly greater in older patients ( P < .001). The older group had 3 perioperative complications ( P = .144) and showed a trend toward a longer hospital stay ( P = .083). There was no difference in visual analog scale, American Orthopaedic Foot & Ankle Society score, or SF-36 among the groups at 6 months or 2 years. Using multiple regression, age was not associated with any outcome score. The satisfaction rates were 82%, 78%, and 83% in the young, middle-aged, and older groups, respectively ( P = .698). There was no difference in the number of reoperations at a mean follow-up of 9.2 ± 2.2 years ( P = .778), and no patients underwent reoperation for recurrent hallux valgus. The risk of recurrence was 5 times higher in older patients compared with younger patients (OR, 5.15; 95% CI, 1.10-24.03; P = .037). Conclusion: Age did not influence the perioperative, functional, or subjective outcomes following hallux valgus surgery. However, older patients should be counseled on the higher risk of recurrence following surgical correction. Level of Evidence: Therapeutic, level III, retrospective comparative series.

show abstract

“…Positive results in the surgical fixation of both hallux rigidus and hallux valgus are well documented across age groups. 7,19 Metatarsophalangeal (MTP) fusion is a reliable method for the treatment of hallux rigidus and is associated with high patient satisfaction and improved functionality. 7 Nevertheless, the effects of psychiatric disorders on surgical outcomes in this population are not well understood.…”

Section: Introductionmentioning

confidence: 99%

Association of First Metatarsal Phalangeal Joint Fusion for Hallux Rigidus With Patient-Reported Pain and Mental Health Outcomes in Patients Taking Psychotropic Medications

Manz

Fink

Novack

et al. 2023

Foot & Ankle Orthopaedics

Self Cite

View full text Add to dashboard Cite

Background: Limited literature examines the relationship between surgical outcomes in chronic foot and ankle conditions and concurrent psychiatric care. The present study aimed to investigate patient-reported and surgical outcomes of patients treated for a psychiatric disorder undergoing first metatarsophalangeal (MTP) fusion for hallux rigidus. We hypothesized that patients on psychotropic medications would have greater subjective pain preoperatively and less improvement in physical and mental functionality postoperatively when compared with nonmedicated patients. Methods: A single-center, retrospective review of prospectively collected data was conducted on 92 patients undergoing first MTP fusion with a preoperative diagnosis of hallux rigidus from 2015 to 2019. At their preoperative, 6-month postoperative, and 1-year postoperative visits, patients were administered visual analog pain scale (VAS) and 36-Item Short Form Health Survey (SF-36) functionality surveys. Patients were subsequently identified by chronic use of psychotropic medication preoperatively and grouped for analysis (MED, n = 42; NO MED, n = 50). Results: Postoperative mean VAS pain scores were lower for all studied patients at 6 months (VAS = 1.6 ± 2.3) and 1 year postoperatively (VAS = 1.1± 1.8) relative to the preoperative visit (VAS = 4.7 ± 2.8) ( P ≤ .0001 and P ≤ .0001, respectively). No differences in mean VAS pain scores nor SF-36 physical component summary scores were detected at preoperative, 6-month, or 1-year visits between NO MED and MED groups. Mean SF-36 mental component summary scores for those in the MED group were lower at preoperative (NO MED = 83.8, MED = 71.8, P = .006) and 6-month postoperative (NO MED = 86.1, MED = 72.7, P = .037) visits than those in the NO MED group, a trend not observed at the 1-year postoperative mark (NO MED = 84.1, MED = 76.8, P = .228). There were no observed differences in operative time ( P = .219), tourniquet time ( P = .359), nor time to full weightbearing ( P = .512) between MED and NO MED groups. Additionally, no differences in postoperative complication rates were observed between groups. Conclusion: In patients treated with psychotropically active medications with hallux rigidus, MTP Fusion appears to be a reasonable treatment choice with similar outcomes for patients requiring psychotropically active medications to the outcomes of those patients not requiring psychotropically active medications. Level of Evidence: Level III, retrospective comparative study.

show abstract

Effect of Age on Complication Rates and Outcomes Following First Metatarsophalangeal Arthrodesis for Hallux Rigidus

Cited by 14 publications

References 21 publications

Ten-Year Minimum Follow-up Study of First Metatarsophalangeal Joint Fusion in Young vs Old Patients

Ten-Year Minimum Follow-up Study of First Metatarsophalangeal Joint Fusion in Young vs Old Patients

Effect of Age on Clinical and Radiological Outcomes of Hallux Valgus Surgery

Association of First Metatarsal Phalangeal Joint Fusion for Hallux Rigidus With Patient-Reported Pain and Mental Health Outcomes in Patients Taking Psychotropic Medications

Contact Info

Product

Resources

About