Outcomes of Iliac Crest Bone-Block Arthrodesis After Failed First MTP Joint Surgery With Bone Loss.

Abstract

Failed first metatarsophalangeal (MTP) joint surgery with bone loss is a challenging revision problem. This study aimed to evaluate the radiographic and clinical outcomes of iliac crest bone-block arthrodesis in this setting. This retrospective cohort included 72 patients who underwent revision first MTP arthrodesis with tricortical iliac crest autograft between 2018 and 2022. All patients had at least 2 years of clinical and radiographic follow-up, and 83.3% had at least 3 years of follow-up. Fusion rates, complications, and changes in visual analog scale (VAS) and 36-Item Short Form Health Survey (SF-36) scores were recorded; the influence of age, comorbidities, and graft length was explored. The median time from the index procedure to revision was 24 months, and the median graft length 11 mm. Primary radiographic union was achieved in 67 of 72 patients (93.1%); after secondary grafting in 3 additional patients, final radiographic union was 70 of 72 (97.2%), with persistent nonunion in 2 patients (2.8%); 44.4% had at least 1 complication and 6.9% required further surgery. Median VAS improved from 8 (7.8-9.0) preoperatively to 0 (0-1.0) at 24 months, and SF-36 improved from 55 (50-62) to 88 (82-90). Exploratory analyses suggested that systemic comorbidities and longer graft length were associated with less favorable pain and functional outcomes. Iliac crest bone-block arthrodesis may be an acceptable salvage option after failed first MTP joint surgery with bone loss, achieving a high radiographic union rate and meaningful clinical improvement; however, postoperative complications were frequent, and outcomes were less favorable in patients with systemic comorbidities or larger structural defects. Level IV, non-comparative retrospective cohort.