Risk Factors for Reoperation After First Metatarsophalangeal Arthrodesis: A Retrospective Case-Control Study.

Abstract

Arthrodesis of the first metatarsophalangeal joint (MTPJ) is one of the most common procedures in foot and ankle surgery. The aim of our study was to explore potential patient-related, radiologic, and surgery-related risk factors for reoperation after first MTPJ arthrodesis. All first MTPJ arthrodesis operations between 2010 and 2020 in Helsinki University Hospital were retrospectively reviewed for patient-related risk factors for reoperation. For radiologic and surgery-related risk factors, all reoperated and a propensity-matched cohort of non-reoperated cases were assessed. A total of 3911 primary operations and 453 reoperations with a mean follow-up of 9.3 years (SD, 2.9; range, 3.8-14.5 years) were assessed. Reoperation rate was 11.6%. Preoperative radiologic grade I arthrosis according to the Coughlin and Shurnas classification (OR 3.81, 95% CI 1.54-9.43) and a greater preoperative hallux valgus angle (OR 1.05, 95% CI 1.01-1.08) were both associated with an increased risk of reoperation. Factors associated with decreased risk for reoperations were using snap-off screws as a fixation method (OR 0.31, 95% CI 0.10-0.91), female sex (OR 0.78, 95% CI 0.61-0.99), age (OR 0.97, 95% CI 0.96-0.98), and greater change in hallux valgus angle (OR 0.95, 95% CI 0.92-0.98). Several patient-related, radiologic, and surgery-related risk factors were associated with increased or decreased risk for reoperation. Our findings identify potential predictors of reoperation; however, causality cannot be inferred because of the retrospective design.