Does Early Weightbearing Affect Fusion Rates of First Tarsometatarsal Arthrodesis with Plate and First Metatarsal-Intermediate Cuneiform Fixation for Hallux Valgus Correction? A Multicenter Study

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: The optimal strategy to achieve hallux valgus deformity correction and 1st tarsometatarsal (TMT) arthrodesis remains controversial. Despite improved understanding of the triplanar deformity and the evolution of fixation methods, concerns over rates of nonunion and recurrence continue to require restricted function during the postoperative recovery period. A 1st metatarsal-intermediate cuneiform (1MT-IC) screw and plate construct is proposed to correct the triplanar deformity and diminish nonunion and recurrence while providing a stable construct for early weightbearing. This study was designed to investigate the effect of early weightbearing on complications and fusion rates after triplanar 1st -TMT arthrodesis with additional 1MT-IC fixation. Methods: The multicenter investigation retrospectively reviewed 67 cases of 1st -TMT arthrodesis with additional 1MT-IC fixation at two academic institutions with an established postoperative weightbearing protocol. No weightbearing was recommended in the immediate postoperative period followed by transition to weightbearing in a CAM boot at the first postoperative appointment at 2 weeks. Progression to weightbearing in standard shoe wear was commenced at the second postoperative appointment at 6 weeks postoperatively. Patients continued to be followed to analyze medial/intermediate column stability and to radiographically document bony consolidation at the arthrodesis site. All complications and unplanned reoperations were recorded. Results: 1st -TMT arthrodesis was achieved in 65 of 67 feet (97.0%) and the mean time to union was 74.7 days (Median: 64.0, Range: 37-272). Radiographic nonunion was identified in two patients (3.0%), but one patient was asymptomatic with clinical union. One patient presented with a deep infection necessitating hardware removal prior to complete consolidation but demonstrated clinical union on final examination. A total of 5 patients (7.5%) requested hardware removal after successful union secondary to dorsal plate irritation. Conclusion: In a multicenter patient cohort, implementation of early protected weightbearing after triplanar 1st - TMT arthrodesis with dorsal plate fixation and 1MT-IC fixation demonstrated maintained angular correction with high rates of union and low complication rates. The most common cause for reoperation was hardware removal secondary to dorsal plate irritation.