Does Decompressive Chevron Osteotomy Decrease Subchondral Bone Density of the First Metatarsophalangeal Joint in Hallux Rigidus?

Abstract

To investigate the impact of decompressive chevron osteotomy on subchondral bone density at the first metatarsophalangeal (MTP) joint. Sixteen feet (12 patients) with hallux rigidus underwent decompressive chevron osteotomy. Standing cone beam 3D computed tomography (3DCT) were assessed preoperatively and at 4-month follow-up, and clinical data were collected. Radiologic measurements, including bone density using Hounsfield units (HU), were conducted. Statistical analyses were performed to evaluate changes and correlations. Postoperative bone density significantly decreased in proximal (Pre, 650.9 ± 149.1; Post, 312.4 ± 115.9; <i>P</i> < .001) and distal (Pre, 910.4 ± 143.3; Post, 639.0 ± 167.1; <i>P</i> < .001) components of the first MTP joint and the first tarsometatarsal (TMT) (Pre, 762.9 ± 166.6; Post, 611.5 ± 165.9; <i>P</i> < .001) joint. No significant difference was measured at the tibiotalar joint (Pre, 497.5 ± 143.6; Post, 534.3 ± 130.7; <i>P</i> = .065). Length of the first metatarsal (Pre, 60.4 ± 3.4; Post, 54.3 ± 3.0; <i>P</i> < .001) and metatarsal protrusion index (MPI) (Pre, -0.9 ± 3.0; Post, -9.0 ± 3.6; <i>P</i> < .001) significantly decreased postoperatively. Clinical assessments showed significant improvements in pain on the visual analog scale (-5.3 ± 1.9). Decompressive chevron osteotomy leads to a significant decrease in subchondral bone density of the first MTP joint. A decrease in bone density occurs also in the first TMT joint. Level IV, radiographic study.