Staged arthrodesis for salvage of the septic hallux metatarsophalangeal joint.

Abstract

Failed surgery at the hallux metatarsophalangeal joint may present substantial difficulties in treatment, especially when complicated by infection. This retrospective study reviews the staged treatment of 5 patients with complications of hallux valgus surgery associated with sepsis of the metatarsophalangeal joint. The initial salvage treatment included debridement with placement of an antibiotic cement spacer and either an intramedullary Kirschner wire (4 patients) or an external fixator (1 patient). At the second stage procedure, the spacer and fixation were removed, and an autogenous tricortical iliac crest graft was inserted into the joint. All patients had clinical control of joint sepsis. Pseudoarthrosis occurred at the proximal end of the tricortical graft in 2 patients. Patients were evaluated at an average of 28 months after the fusion. Staged arthrodesis appears to be a satisfactory approach to postoperative sepsis of the hallux metatarsophalangeal joint.