Association Between Sesamoid Position and Long-Term Outcomes Following Triplanar Tarsometatarsal Arthrodesis at 4-Year Follow-up.

Abstract

-Hallux valgus (HV) is recognized as a triplanar foot deformity with optimal surgical results achieved when all three planes are addressed. We have previously reported on an ongoing 5-year, prospective, multicenter, clinical study using instrumented correction of the first tarsometatarsal joint (1^st TMT) in patients with HV. -This report details interim 48-month results of this study, evaluating the impact of early postoperative tibial sesamoid position (TSP) on radiographic recurrence (postoperative hallux valgus angle (HVA) measurements of >15°), and whether radiographic recurrence impacted patient-reported outcomes. - One hundred seventy-three patients were included in this multicenter study, of whom 146 patients achieved their 48-month visit. Radiographic parameters were presented at baseline, 6 weeks and 48 months. This included intermetatarsal angle (IMA) along with TSP and HVA. - Institutional review board approval was obtained for each study site. A consecutive cohort of patients were enrolled from November 2018 to April 2021 who received 1^st TMT arthrodesis to correct their hallux valgus deformity. Inclusion and exclusion criteria were established. - At the 48-month follow-up, 12 patients (8.2%) had radiographic recurrence with an HVA>15°. Evaluation of TSP position at 6-weeks postoperative found that a TSP≤ 3 reduced the likelihood of recurrence by 95% compared to a TSP>3. - The results of this interim analysis suggest that initial correction of axial rotation and sesamoid position of the first ray is important in maintaining correction long term and favorable patient reported outcomes.