Correction power and complications of first tarsometatarsal joint arthrodesis for hallux valgus deformity.

Purpose: First tarsometatarsal joint (TMTJ) arthrodesis is known as a powerful operative procedure to correct moderate to severe hallux valgus deformity. However, there is little evidence about actual complication rates and angular correctional power. The aims of the present study were to evaluate the (1) angular correction power and (2) complication rates of pooled data for this procedure and to perform subgroup analysis of different methods of fixation.

Methods: A systematic search for the MeSH terms "(hallux OR bunion) AND (lapidus OR TMT OR tarsometatarsal OR metatarsocuneiform) AND (fusion OR arthrodesis)" with use of the online databases MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews was conducted.

Results: Twenty-nine studies with a total amount of 1,470 operated feet in 1,268 patients with a mean age of 46.9 years (range, 16.5-61.9) and a mean follow-up period of 28.5 months (range, 6.0-75.6) were included. The correction of IMA averaged 9.12 degrees for screw fixation, 9.75° for staple fixation, 12.41° for combined locking plate with screw fixation, 14.36° for screw with K-wire fixation, 8.50° for pin fixation and 8.60° for external fixation (p = .0251). The overall complication rate reached 16.05 % with a nonunion rate of 4.01 %.

Conclusion: Based on meta-analysis data, first TMTJ arthrodesis reveals higher corrective power compared to meta-analysis data on proximal, diaphyseal and distal metatarsal osteotomies.