Management of Chronic Septic Arthritis and Osteomyelitis Following Hallux Valgus Correction With Staged Antibiotic Cement Spacer and Subsequent Bulk Allograft Arthrodesis.

Abstract

A 63-year-old previously healthy woman presented with chronic septic arthritis and osteomyelitis of her first metatarsal and proximal phalanx following attempted hallux valgus correction 4 months prior at an outside institution. Treatment involved culture-directed antibiotics and multiple surgical débridements until bone margins were negative for osteomyelitis. Antibiotic cement spacers were used after surgical débridements to aid with infection clearance and to help preserve first ray length. Definitive surgery was performed once infection was cleared, and the patient ultimately underwent successful bulk allograft first metatarsophalangeal joint arthrodesis. At over one and a half years postoperatively, the patient shows no signs of recurrent infection and ambulates pain-free in regular shoes. An antibiotic cement spacer can be considered to help treat first metatarsophalangeal joint chronic septic arthritis and associated osteomyelitis to maintain the length of the first ray before bulk allograft fusion. This case highlights a valuable option for limb salvage in the treatment of complex forefoot infections.