From the Guidelines
MTP fusion is a viable option to fix hallux valgus instead of revision of a Lapidus bunionectomy, particularly in cases with severe deformity, arthritis, or failed previous bunion surgeries, as it provides excellent correction and durability, despite sacrificing joint motion. When considering the treatment options for hallux valgus, it is essential to weigh the potential benefits and drawbacks of each approach. MTP fusion, also known as first MTP arthrodesis, involves permanently fusing the joint between the first metatarsal and the proximal phalanx of the big toe, eliminating motion but providing stability and pain relief 1. This procedure is typically reserved for more severe cases or revision scenarios because it sacrifices joint motion.
The decision between MTP fusion and Lapidus revision should be individualized based on the patient's age, activity level, degree of arthritis, and specific anatomical considerations. For instance, patients with severe deformity, arthritis in the first metatarsophalangeal (MTP) joint, or failed previous bunion surgeries may benefit from MTP fusion. On the other hand, patients with mild to moderate deformity and no significant arthritis may be better candidates for Lapidus revision.
Key considerations for MTP fusion include:
- The procedure involves removing the remaining cartilage, positioning the toe in functional alignment (typically 10-15 degrees of dorsiflexion), and securing it with screws, plates, or other fixation devices.
- Recovery typically requires 6-8 weeks of protected weightbearing in a surgical shoe or boot, followed by gradual return to normal footwear over several months.
- Patients should understand they will permanently lose motion at this joint, which may affect activities requiring toe flexibility like running or wearing high heels.
- The potential benefits of MTP fusion, including excellent correction and durability, must be weighed against the potential drawbacks, such as sacrificing joint motion.
Ultimately, the choice between MTP fusion and Lapidus revision depends on a thorough evaluation of the patient's individual needs and circumstances, and should be made in consultation with a qualified healthcare professional.
From the Research
MTP Fusion as a Viable Option
- MTP fusion is a surgical procedure that can be used to correct hallux valgus deformity, particularly in cases where revision of a Lapidus bunionectomy is considered 2, 3.
- The Lapidus procedure involves arthrodesis of the first metatarsocuneiform (MTC) joint and is effective in correcting moderate to severe hallux valgus deformity 2.
- However, the Lapidus procedure has a higher complication rate and a longer postoperative rehabilitation period compared to other surgical procedures 3.
Comparison with Lapidus Bunionectomy
- The Lapidus bunionectomy is a powerful technique for correcting hallux valgus deformities, but it has a higher pseudarthrosis rate of up to 12% 4.
- MTP fusion may be a viable option for patients who have undergone a Lapidus bunionectomy and require revision surgery 2, 5.
- A study comparing different osteosynthesis methods for Lapidus bunionectomy found that an interfragmentary screw and a plantar plate had better outcomes compared to an interfragmentary screw and a dorsomedial locking plate 4.
Outcomes and Complications
- The outcomes of MTP fusion and Lapidus bunionectomy can be evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Visual Analogue Pain Scale (VAS) 2, 6.
- A study on minimally invasive surgery for hallux valgus correction found that the mean AOFAS score was 87.15 points at the final follow-up of 48 months, and the VAS score was 8.35/10 6.
- The complication rate for MTP fusion and Lapidus bunionectomy can be significant, with nonunion of the first MTC joint occurring in up to 10.3% of cases 2.