Disclosures/Conflicts There were no grants No Disclosures as - - PowerPoint PPT Presentation

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Disclosures/Conflicts

There were no grants No Disclosures as related to this talk There were no potential conflicts of interest.

Introduction

Hallux valgus deformity common

• (Bock et al. JBJS Br 2004, Roukis et al. JFAS 2005)

15-20% dissatisfaction rate after hallux valgus correction

• (Smith et al. FA 1984, Coughlin et al. JBJS Am 2007)

1st MTP joint lesions have been associated with hallux valgus deformities

• (Bock 2004, Lui 2008, Roukis 2005)

But…

Characterization of OCD in hallux valgus? Correlation of cartilage lesions to patient symptoms/outcome? Correlation of cartilage lesions to severity of deformity? Prospective evaluation lacking

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Goals

Detail articular erosion patterns Evaluate if damage is associated with deformity Prospectively evaluate effect on

• utcomes

Hypothesis

Lesion grade and surface area would correlate with radiographic measures of deformity and patient clinical outcomes

Materials/Methods

• Inclusion:
• Isolated pain
• Hallux valgus
• Refractory to non-op

Exclusion:

Rheumatoid Inflammatory arthropathy Traumatic origin Revision DM neuropathy

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Methods: Radiographic Outcomes

Traditional Angles:

• HVA, IMA, HVIP,

DMMA

Grading-

(Coughlin (JBJS Am 2003)

Methods: Clinical Outcomes

• VAS
• Walking tolerance
• Subjective numbness
• AOFAS
• Grading- International

Cartilage Repair Society scale

• Location
• (Roukis et al. JFAS 2005)

Pearson’s correlation coaefficient, student t-test, Post hoc power analysis- 44 would provide 90% power

Results

56 feet 91% with lesions At 24 months:

VAS 5 1, AOFAS 59 89 HVA 24 9, IMA 14 5

1 reoperation to fusion

Often these are below the “equator” and not actually seen during bunion surgery

*Mean area 50 mm2 *Avg grade 3 *80% were inferior > superior, medial > lateral *size/grade did not correlate w/age or differ by gender

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Hallux valgus As oppose to Hallux rigidus

DORSAL

5/8/2014 5 lesion max grade/number of lesions vs. radiograph outcomes lesion max grade/number of lesions vs. radiograph outcomes lesion max grade/number of lesions vs. radiograph outcomes

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lesion area vs radiographic outcomes lesion area vs radiographic outcomes

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Discussion

Roukis et al. (JFAS 2005)

Proposed map 100% w/ lesions >50 yo Realign in young

Lui et al. (Arthroscopy 2008)

Correlated HVA to prevalence of OCD of 1st MTP

Doty et al. (FAI 2013)

Cadeveric study- ant/inf > superior lesions More zones, higher grade of lesions Correlated grade/size to angular deformity

Conclusions

• OCD in Hallux Valgus are anterior/medial/inferior
• No Correlation

– High prevalence? – Pain Multifactorial? – Evaluation sensitive enough?

• Significance of these lesions is unknown
• fusion or chondral repair techniques needed?
• Not poor prognostic factors
• Realignment procedures are not contra-indicated

Thank You