Management of recurrent hallux valgus accompanied by angular deformity and arthritis with first metatarsophalangeal joint arthroplasty

Objectives: The aim of the study was to evaluate the effectiveness of total toe arthroplasty in patients with deformities repeatedly accompanied by first Metatarsophalangeal joint arthrosis following unsuccessful Hallux valgus surgery. Methods: Evaluation was made of a total of 12 cases with previous surgical treatment for a diagnosis of Hallux valgus who developed recurrence and joint arthritis (10 females, 2 males, Mean age: 64.9 years; range, 58-71 years). Preoperatively, the Hallux valgus and the intermetatarsal angle grades of all patients were determined according to the Kellgren-Lawrence radiological criteria, and the first toe length and the total range of movement, in addition to the American Orthopaedic Foot and Ankle Society (AOFAS) scores were determined. The postoperative H. Valgus and the inter-metatarsal angles and the acute recovery angles were determined. Finally, the Hallux valgus, the inter-metatarsal angles and loss of correction compared to the early post-operative period, the first metatarsal-phalangeal joint movement range and the final AOFAS score were evaluated. The mean follow-up duration was 51.5 months (range, 38-64 months). Results: The mean H. valgus angle was 32.3 degrees +/- 2.64 degrees preoperatively and 13.8 degrees +/- 2,37 degrees in the early post-operative period (P<0.001). The mean intermetatarsal angles was determined as 10.5 degrees(range, 9 degrees-12 degrees) preoperatively and 9.5 degrees(range, 9 degrees-12 degrees) postoperatively at the final measurements (P>0.001). The mean preoperative toe length was 48.5 mm (range, 42-58 mm) and 48.2 mm (range: 42-57 mm) postoperatively (P>0.001). Range of motion was measured as mean 24 degrees(range: 18 degrees-28 degrees), preoperatively, and 26.6 degrees (min: 22 degrees-max: 32 degrees) postoperatively. AOFAS values of mean of 56.5 (range, 52-64) preoperatively, increased to mean 83.9 (range, 66-90) postoperatively (P<0.001). Conclusions: The results showed that corrective first MTP joint total arthroplasty applied to selected Hallux valgus cases with accompanying arthrosis, has satisfactory clinical and radiological results in the mid-term follow-up examinations.