Autograft use, nonuse did not impact primary hallux metatarsophalangeal joint fusion rate
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SAN DIEGO — Regardless of whether calcaneal autograft bone was used in primary hallux metatarsophalangeal fusions, results of a retrospective study presented here showed about 90% of patients had a successful union.
J. Kent Ellington, MD, MS, FAAOS, a co-author of the study that was presented at the American Academy of Orthopaedic Surgeons Annual Meeting, told Healio Orthopedics, “In the current analysis, adding calcaneal autograft to an [metatarsophalangeal] MTP fusion procedure doesn’t necessarily improve our fusion rates. However, there’s no complications in our series from the donor site and there may some selection bias that went into the study.”
Ellington and colleagues conducted a chart and radiographic review to determine whether differences in hallux MTP joint fusion rates would be seen with or without the intraoperative addition of calcaneal autograft bone. They studied results of 336 patients (140 received autograft; 196 did not receive autograft) who underwent the procedures from February 2016 to February 2019 and were tracked in the OrthoCarolina administrative database.
Based on the abstract, the preoperative diagnosis was hallux valgus in 52.7% of patients and hallux rigidus in 39.9% of patients.
The primary outcome was successful union of the hallux MTP joint. Researchers wrote in the abstract, “Surgeon preference dictated use of autograft, as some in our group routinely use graft while others do not.”
Results showed 89.9% of patients had successful union at a mean follow-up of 14.8 weeks and there was no significant difference in the union rates of the groups, with 87.9% for arthrodesis with autograft and 91.4% without autograft.
“I would add to that a lag screw did not increase fusion rate,” Ellington said and noted it is surgeon preference whether to use a lag screw with the plate and that he has never found it to be effective for this procedure.
In a health care environment that is focused on value-based care, a 4.0-cannulated screw may cost $300 to $400 and take about 5 to 10 minutes to implant, he said. “It is a real timestamp for lag screw,” Ellington told Healio Orthopedics.
The complication of painful hardware occurred in 8.6% of patients. Furthermore, smoking and a diagnosis of diabetes did not seem to affect union rates, based on the abstract.
Ellington said a subgroup analysis regarding differences in fusion rates for patients with a diagnosis of diabetes or who smoked has not yet been done but is expected soon.
“I think that would be interesting. I can see how maybe that would be impactful for our field, and for that, I would probably be interested in using the autograft in patients that I thought might need it or, if I was in the case, found anatomical reasons to use it, as well,” he told Healio Orthopedics.
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Finney F, et al. Paper 220. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Aug. 31-Sept. 3, 2021; San Diego.
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